Perennial Allergy Relief: A Practice Builder

Spring brings seasonal allergies, but it also is important to provide eyecare for patients with perennial allergies unrelated to seasonal changes. You will be rewarded with loyal patients who let others know of your services.

Allergies related to the change of season in the spring and fall is so common that many think exclusively of it when the topic of ocular allergies comes up. Providing for seasonal allergy patients is essential, but don’t overlook another segment of allergy suffers–those with allergies unrelated to these common factors. Here are key points to keep in mind to serve patients with allergies that don’t go away with the passing of spring or fall.

May Be a Systemic Reason for Allergies

Most nonseasonal, ocular allergies are associated with dust or dust mites, animal dander or mold. Another chronic ocular allergy called vernal conjunctivitis worsens in warm weather, but is not due to typical seasonal triggers such as pollens. Instead it is an IgE mediated mechanism found in some patients who also have a family history of other atopic diseases such as asthma, eczema or hay fever. GPC (giant papillary conjunctivitis) may also result as a form of ocular allergy to long-term buildup of deposits on contact lenses worn for a prolonged period of time. Acute reaction to some forms of cosmetics is also not uncommon.

Bill Medical, Rather than Vision, Insurance

The amount of reimbursement varies from one insurance company to the next, but you would generally receive approximately $90 to $110 for the initial visit and $39 to $65 for each follow-up visit. You should typically see the patients an average of three times to diagnose, begin treatment and follow up until their symptoms are resolved and they are stable, and then again several months later to make sure they are still OK.

A Potentially Significant Group of Patients

The more severe cases are chronic allergies. Chronic allergies often can be inherited and/or the patient has a history of hay fever, asthma or eczema. Patients are typically younger–early 20s or younger. It is more common in males than females. Many of these cases are children. Practicing in the tropics also had an impact with warm weather often worsening the symptoms. Long-time contact lens wearers who wore extended wear lenses without frequent replacement, who then developed GPC, also were common. Middle-age females would account for most of the cosmetic reactions leading to allergies.

Know the Signs of Non-Seasonal Allergies

Most of the time these patients would come in complaining of discomfort and show clinical signs such as moderate to severe injection, minimal to moderate lid edema or just heaviness of their eyelids. Other common signs of  this form of allergies include mucus discharge, itching and/or burning eyes. At times these patients also would experience concurrent rhinitis. Other times they would complain of contact lens intolerance and come in wanting a new contact lens prescription thinking that is what they need.

Prepare to Treat Non-Seasonal Allergies

There is no special equipment beyond the typical instrumentation needed to diagnose this form of ocular allergy. Most of the examination can be done directly and with the aid of a slit lamp. Corneal dyes are often used to aid in the examination.

Understanding the pathology and clinical picture of these conditions and the differential diagnoses is important. Along with taking advantage of ocular allergy learning opportunities at conferences, keeping up with the related medical literature is also extremely helpful.

Educate Your Patient

Helping the patient understand what is happening to their eyes and explaining both the realistic short- and long-term expectations are what most patients want, in addition to the most rapid relief possible. This will provide the patient piece of mind. If there is something the patient can do to improve their situation and prevent issues in the future, such as more frequent replacement of contact lenses (like daily replacement), then explain why this change is necessary and how a change in their contact lens routine may lead to greater comfort.

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Make the Treatment of Ocular Allergies a Practice Profit Center

Ocular allergies affect millions of Americans—and you can treat their symptoms. Here’s how to code and bill correctly to make this service a profit center in your practice.

The bad news is that ocular allergies affect a large percentage of your patient population. The good news is that ocular allergies affect a large percentage of your patient population.

Allergic conjunctivitis is an ocular disease that optometrists can diagnose and treat. The best news about this condition is that you do not have to invest in any expensive instrumentation besides your slit lamp to care for these patients. In addition, these patients are loyal to your practice because you are alleviating their allergy symptoms and will continue to return every year because allergic conjunctivitis is typically a chronic condition that returns year after year.

Beyond providing care, here is what you (and your staff) need to know about coding and billing for this treatment.    

Diagnosis codes for allergic ocular disease includes the following:
370.32  Limbal and corneal involvement in vernal conjunctivitis
372.05  Acute atopic conjunctivitis
372.13  Vernal conjunctivitis
372.14  Chronic allergic conjunctivitis
373.32  Dermatitis of eyelid, contact and allergic

All of these diagnosis codes are acceptable billing codes for External Ocular Photography 92285 which has an average Medicare allowable of $23 and is a bilateral procedure.  External ocular photography is billable when it is used to measure the progress or deterioration of ocular tissue associated with ocular allergic disease. 

Two Major Categories of Allergic Conjunctivitis

Allergic conjunctivitis is divided into two major categories: seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). SAC and PAC are triggered by an immune reaction involving a sensitized individual and an allergen. Ideally, if an individual can pinpoint what they are allergic to and avoid it then their symptoms will be minimal. However, if they are experiencing ocular symptoms they may need the care of their optometrist.

Typical symptoms include:
      •    Watery eyes
      •    Itchiness
      •    Sensitivity to light
      •    Redness
      •    Grittiness
      •    Eyelid swelling

The main difference between SAC and PAC is the timing of the symptoms
Patients with SAC experience symptoms for a short period of time. They may be bothered in the spring by tree pollen, in the summer by grass pollen, or in the fall by weed pollen. Generally, their symptoms resolve during other times of the year, especially in the winter. Patients with PAC experience symptoms throughout the year. Instead of outdoor allergens, they have problems with indoor allergens, such as dust mites and pet dander. Seasonal outdoor allergens may worsen their complaints if they are sensitive to them as well.

If a patient presents with allergic conjunctivitis you should attempt to determine whether it is seasonal or perennial to better decide how often you need to see the patient. A good history of previous episodes or evaluating current symptoms will help you decide.