To register for the annual meet-ing, contact Dr. Richard Hultsby e-mail at reh@drhults.com

and contact Kim Collings to bookhotel and air (800.233.7790 or e-mailkcollings@travelhouseagency.com).

Here are highlights of the Nov. 5-9meeting in Playa del Carmen.

Sunday, November 5◆ 12:30 p.m. Golf at Play-acar Golf Club◆ Evening: Welcome reception

Monday, November 6◆ Presentations by title spon-sors Alcon and CooperVision

◆ Spouse trip to Cancun—for beach visits and/orshopping ◆ Afternoon: Vendor Fair

Tuesday, November 7◆ Dr. Gelb’s six hours ofCE on medical proceduresconcludes.◆ Familysnorkelingday to Xel Ha,a spectacularnatural aquar-ium and waterpark

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

ALLDocsALLDocsThe

NewsletterRx Therapeutics for Practice Growth

Third Quarter 2006

Steve Lutz, O.D., Ann Arbor,MI, recently became concernedabout potential interactions be-

tween some multi-purpose solutions

Annual MeetingNovember 5-9 Mexico

Solution Choice Improves Success RateSolution biocompatibility an issue for many contact lens wearers

and specific contact lens materials,particularly the new silicone hydrogelmaterials. Dr. Lutz had been dispens-ing a polyhexamethylene biguanide-

based multi-purposesolution with anew silicone hydro-gel lens design, andhe became aware ofthe potential forsignificant cornealstaining.

Dr. Lutz rou-tinely is using theAndrasko Corneal Staining Grid(www.staininggrid.com), in the selec-tion of the lens materials and multi-purpose solutions. The grid showscorneal staining associated with vari-ous solution and contact lens materi-al combinations. Dr. Lutz says thefindings in the grid, which he andhis associates use when they are rec-ommending the most biocompatiblesolution for the prescribed contactlens, adds credence to what he tellshis patients.

Dr. Lutz

¡Arriba! Make Your Plans for Mexico

Continued on page 4

◆ Morning meeting: Four hours ofCE, sponsored by Alcon. MurrayFingeret, O.D., F.A.A.O., New York,

NY, talks about glaucomatreatments: “Who toTreat; When to Treat;Medication Updates.”◆ Six hours of CE, spon-sored by ALLDocs. KerryGelb, O.D., reviews med-ical eye procedures in threehours of lecture and three

hours of lab. Continues on Tuesday. Continued on page 4

Biocompatible Combinations Related to Corneal Staining1,2

References: 1. Contact Lens Research Services. Andrasko corneal staining grid. Available at http://www.staininggrid.com. Accessed September 8, 2006.2. Andrasko GJ, Ryen KA, Garofalo RJ, et al. Compatibility of silicone hydrogel lenses with multi-purpose solutions. Alcon Laboratoires, Inc. Poster presentedat: ARVO; April 2006; Fort Lauderdale, FL.

Solution UNISOL®4 OPTI-FREE® ReNu CompleteType Saline Control RepleniSH® MultiPlus* MPS MoisturePLUS*

MPDS Available in private label MPS

1% 5% 1% 2%

2% 7% 73% 48%

2% 5% 9% 5%

2% 5% 24% 18%

2% 3% 24% 16%

ACUVUE* 2

PureVision*

OASYS*

O2OPTIX*

NIGHT & DAY*

Len

s Ty

pe

% S

tain

ing

†

†Average amount (area) of corneal staining at 2 hrs.Information is based on the results of 5-period crossover study design (N-30). Data updated July 20, 2006

*Trademark of another companyFor a complete and updated grid see www.staininggrid.com

10% 10%-20% >20%

ALLDocsALLDocsThe

Newsletter2

The health history questionnairefor patients in the Asheville, NC,practice of Sid Morse, O.D., in-

cludes several questions about dry eye.“I find that often patients say they use

a lubricating drop once or twice a week, but

their dry eye symptoms persist,” he ex-plains. “At that point, I switch them toSYSTANE® Lubricant Eye Drops and instructthem to use the drops several times eachday.” Often, that switch is sufficient, Dr.Morse says. And if it’s not, it becomes docu-

mentation in the pa-tient’s record that regularuse of lubricant dropsdidn’t resolve the prob-lem. That’s a step in the guidelines for med-ical billing for punctal occlusion, he says.

“If in the course of an eye exam I feelthat the patient might benefit from theuse of SYSTANE®, I’ll recommend it andnot bill medically for it,” Dr. Morse says.“But if the symptoms don’t resolve fully,the fact that the patient was using itmakes the case for me that this is a med-ical dry eye issue. Then I’ll move into pre-scribing Restasis* in conjunction withSYSTANE® or punctal occlusion. Then wemove into medical billing for those servic-es,” he says. Dr. Morse says he’ll recom-mend SYSTANE® Free Lubricant Eye Dropsfor any patient who is likely to use thedrops multiple times each day.

Whether the patient has bothersomesymptoms of dry eye or a medical case ofdry eye, Dr. Morse says the complaint iscommon and a potential practice-builder.Any time he can tell patients about theservices he offers, “in the long run, itdoes help build the practice. They telltheir friends, and my reputation as amedical service provider grows.” ■

*Trademark of another company

FROM THE PRESIDENT’S DESK

Mexico BeckonsIt’s not too late to make plans to at-

tend the annual meeting in Playa delCarmen, Mexico, from Nov. 5-9. In fact,there are dozens of reasons to do soright away. We’re going to have agreat program—our best yet. Special thanks to Dr.Richard Hults for all of his work preparing theprogram. He was also the brain trust behind ourmeetings in Miami in 2005 and Las Vegas in 2004.

Be sure to review the tentative agenda startingon page 1. You’ll see that we have something for everyone: 10 hoursof CE and practical support for O.D.s working to build their practices,fun events for family members and spouses, and free time to enjoythe spectacular surroundings of the Mayan Riviera.

This will be the best meeting we’ve had. The locale, the hotel andthe camaraderie combine to make this the best meeting of the year.More than 80 O.D.s have already signed up. Please join us.

We look forward to seeing you there.Kerry Gelb, O.D.

drkmg@comcast.net

Dr. Gelb

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

Bronze Sponsors:ABB OpticalArt OpticalEssilor of AmericaOptosPrioTopconWalman OpticalZeaVision

Title Sponsors:AlconCooperVision

Gold Sponsors:AMOBausch & LombCIBA VisionVistakon

Be sure to visit our sponsors at the Vendor Fair to be heldMonday and Wednesday afternoons and Thursday morn-ing during the annual meeting.

Vendor partners supporting the annual meeting are:

Special Thanks to Sponsors

Treat Dry Eye Symptoms for Patient Comfort, Profitability

ALLDocs Web SiteLaunched

Go to www.alldocsod.com

appropriate medical diagnosis.Remember to make sure that your

medical record is thorough and estab-lishes medical necessity and that you arefollowing the guidelines of the level ofcase history, examination performed andmedical decision-making performed. Ifthe practitioner approaches the medicalmanagement of this patient appropriate-ly by recognizing the medical nature ofthe solution/lenses interaction, then thepatient and the practitioner can have apositive outcome by prescribing an ap-propriate combination system of solu-tion and lenses and billing the medicalcarrier for the resolution of the present-ing corneal and lid reactions. ■

3ALLDocsALLDocsThe

Newsletter

Implementing the Medical ModelOcular surface disease and contact lens solutions problems often co-present

By John Rumpakis, O.D., M.B.A.

Anew patientsays he wearshis two-week

hydrogel disposablelenses for seven to10 weeks and occa-sional extendedwear, and hasswitched to a genericcontact lens solu-

tion. The patient complains of decreasedwearing time and redness. A comprehen-sive eye exam and refraction, with exter-nal ocular evaluation, shows large peri-limbal loops extending deep into the pe-ripheral cornea. Superior tarsal examina-tion shows moderately large papillae ex-tending to the lash line. The quantityand quality of the tear film are question-able, showing many areas of significantsurface staining. The balance of the ex-amination essentially is unremarkable.The patient is refitted in a two-week dailywear disposable contact lens and pre-scribed OPTI-FREE® RepleniSH™ MPDS.

Two weeks later, the patient has no-ticed significant improvement in ocularcomfort, tolerates the lenses well and is nolonger bothered by redness. However, thequality and quantity of the tear film re-mains unchanged, and staining is stillsignificant. The patient is prescribedSYSTANE® Free Lubricant Eye Drops touse b.i.d. at a minimum, and throughoutthe day if the contact lenses are removed.

Let’s look at the medical codingthat would accompany this case, as-suming that an appropriate case history,examination and medical decision ele-ments are properly recorded.

Initial PresentationComprehensive Ophthalmological Exam

(new patient) 92004Determination of Refractive State 92015Fitting of Contact Lenses

(not including follow-up care) 92310

Two-Week VisitE/M Problem Focused

(established patient) 99213

With the advent of silicone hydrogellenses, practitioners have had to be muchmore cognizant of prescribing a systemof lenses and solutions together for opti-mal performance, comfort and health.With the potential interaction and poten-tial reactivity of specific solution and lenscombinations, corneal staining and lid re-actions may be observed. When presentedwith this in the clinical setting, realize thatyou have a medical eye condition thatmust be addressed, treated and resolved.This would not fall within the “contactlens follow-up” visit category, where youwould provide the medical eye care in apre-determined package price, but wouldbe billable to the medical carrier with the

Dr. Rumpakis

Punctal Occlusion

Let’s say that in the case above, while SYSTANE® Free Lubricant EyeDrops solved a significant degree of the dryness, the patient re-

quired a more permanent solution—punctal occlusion. On the nextvisit, collagen plugs are inserted into both of the inferior puncta. Thisvisit, incorporating the occlusion of the inferior puncta, would be cod-ed as follows, using the E modifiers to note the inferior puncta. Beaware that some carriers currently are limiting the provider to occlud-ing only two puncta per visit.

Punctal OcclusionOcclusion of the puncta, lower left 68761-E2Occlusion of the puncta, lower right 68761-E4

Also know that coding for punctal occlusion has become more com-plicated in recent years because of carrier requirements of medical ne-cessity and documentation guidelines. Keep in mind that medical neces-sity rules the day, and whatever testing you do to establish the need forocclusion (e.g. QuickZone, lissamine green or Schirmers) must berecorded. It is critical that before you bill for punctal occlusion you be-come very familiar with your local coverage determinations (LCDs) forCPT code 68761, occlusion of the puncta by plug. Since many carriersfollow your regional Medicare policies, be aware of changes in policy.For example, the recent interpretation of policy by the OIG (Office of In-spector General) suggests that one should no longer bill for the officevisit on the same day as punctal occlusion unless the office visit is forwork performed over and above the standard work associated withthis surgical procedure. If you do bill an office visit on the same day asthe surgical procedure, be sure to use modifier -25 to qualify the officevisit as separately identifiable, and make sure that your medical recordclearly reflects the additional work required. Take special note to recordthe prior recommendation of the palliative therapy, as many carriers re-quire that medical necessity be established and documented.

If you follow the simple guidelines that are provided to all of us,it is easy to benefit both your patient and your practice. ■

4 ALLDocsALLDocsThe

Newsletter

Harvard Sylvan, O.D.Director, Professional Development

For the past few years, there has been an un-precedented marketing emphasis, both to the

doctor and directly to the patient, on oxygen per-meability as the factor for successful daily wear.

However, there is a growing realization that oxy-gen permeability is just one of several important fac-tors for successful daily wear. In the May 2006 issueof Contact Lens Spectrum, Vistakon’s Derrick Artis,O.D., wrote, “A perfect hydrogel lens would allowfor adequate oxygen to minimize hypoxic complica-tions, yet it would retain beneficial conventional hy-drogel characteristics such as low modulus to help

maximize successful lens wear.”In an April 2006 Review of

Optometry article, Art Epstein,O.D., stated, “There is an emerg-ing realization that oxygen trans-missibility is not the end-all, be-allof ocular health, as was once thought. After a cer-tain point of Dk/t is reached, a law of diminishingreturns takes hold, and other characteristics of a lensbecome just as significant, if not more so.”

Our patients trust us to fit them with lenses thatsatisfy their needs, regardless of marketing hype. Af-ter meeting the criteria to achieve good vision andsafeguard ocular health by prescribing a lens with aDk/t of higher than 24 for daily wear (the Holden-

Mertz Criteria for sufficient oxygentransmission), then a lens that pro-vides the most comfort would seem tobe the ideal choice.

PC Hydrogel™ lenses have morethan adequate Dk/t—44 for two-weekXC™ lenses and 52 for monthly Pro-clear® Compatibles—and excellent op-tics. However, these lens materials’ re-sistance to both dehydration and de-posits makes them the most comfort-able choice for your patients.

Please contact your CooperVisionrep for updated information aboutspecial offers and promotional pro-grams for the entire PC Hydrogelfamily of lenses. ■

Does Oxygen Permeability LimitDW Hydrogel Success?

GUEST COLUMN FROM COOPERVISION

Dr. Sylvan

Reconnect with Dr. Sylvan

Dr. Harvard Sylvan is no stranger to ALLDocs. For 15 years,he held leases in three Connecticut LensCrafters locations. He

served as ALLDocs president from 1995 to 1999 and continued asa board member through 2001. In addition, he served for fouryears as a member of the OAC.

Dr. Sylvan says, “I am very pleased to be working at Cooper-Vision. We have a very exciting pipeline of contact lenses that willbe released over the next two years. Most important to me is thatin my role as Director of Professional Development, I will have theopportunity to see so many of my ALLDocs friends more frequently.”

Dr. Sylvan encourages questions—or hellos—and can be reacheddirectly at 203.214.1812 or at hsylvan@coopervision.com. ■

“My review of the scientificstudies on lens and solution combi-nations, along with my experiencewith the silicone hydrogel lens, hasforced me to look patients right inthe eye and say, ‘Silicone hydrogellenses have a ton of advantages. Butthey’re finicky. I recommend patientsdo not switch to generic solutions. Irecommend they use OPTI-FREE®

RepleniSH® Multi-Purpose DisinfectingSolution.’” ■

SolutionContinued from page 1

Plans for MexicoContinued from page 1

Wednesday, November 8◆ Session: Craig Thomas, O.D., onmedical billing and medical modeloptometry ◆ Seminar: Re-claiming ContactLens Profitability◆ Afternoon ses-sion: Lens-Crafters execu-tive team

◆ Afternoon: Vendor Fair◆ Spouse trip to ancientMayan ruins at Tulum

Thursday, November 9◆ Morning: Vendor Fair◆ Departures