By Jeanmarie Davis, OD 
Handling eyecare emergencies is a critical practice service that builds patient loyalty. To provide this service well, you must ready your staff and also get the word out so patients think of you when an eye emergency arises.
Making sure your practice is ready to handle eyecare emergencies is the right thing to do as a doctor. It also is makes business sense because you want your patients to know they can come to you for any problem with their eyes. Patients like to feel secure that they will be taken care of, and they will stay loyal to a practice that lets them know they can handle emergencies. You, in turn, have an opportunity to win new patients over. Patients who seek a new eyecare practitioner for emergency eyecaremay stay with that doctor because the new doctor has gained their confidence, or for convenience. This can be very profitable. But first you must be personally prepared to handle emergencies and train your staff to handle emergencies, as well. You also must let your patients know you are the first person to call with any discomfort or injury.
Coding and Billing for Emergencies
Emergency eyecare can be a practice builder, but only if you learn how to efficiently code and bill for it. Here is an outline to follow to ensure you receive maximum reimbursement for your services.
Emergency Eyecare Coding Outline
Emergency visit code
Examination procedure code
Additional procedures code
Treatment code
NOTE: Some third-party providers do not pay for emergency codes with optometrists. This is carrier-specific.
And don’t forget to have the patient sign an informed consent document before instituting treatment.
–ROB Editors
True eye emergencies happen on a regular basis and can include red eyes, painful eyes, eye trauma, PVD, symptomatic retinal holes or detachments, corneal abrasions and infections. Any time a patient is in pain or is uncomfortable may be considered an “emergency” in the patient’s mind. Something as simple as an ocular allergy may be considered an emergency to the patient if they are in enough discomfort. These cases represent business you do not want to lose, as well as an opportunity to care for your patient when they need you.
Multiple Cases Per Week
When I was in practice in Hialeah, Fla., it was not unusual for me to see five to 10 “emergencies” per week. Common emergencies include metallic foreign body embedded in the cornea, acute infiltrative keratitis from contact lens wear, anterior uveits, hyphema and subconjunctival hemorrhage (not necessarily a real emergency all of the time but certainly an emergency to the patient).
There is no average age for ocular emergencies. It depends on the patient base. Most patients with metallic foreign bodies were middle-aged males in my patient population. Most contact lens-related keratitiscases were young to middle-aged females. The most common emergencies are more dependent on the patient base than anything and will vary from office to office.
Provide Safety-Related Products and Schedule Exams
There is always an opportunity for additional sales of product and services whenever you get a patient into the office. These opportunities are selling safety products, scheduling the patient back for routine care, scheduling other family members and getting an advocate into the community who will tell others about your practice.
From an emergency standpoint, purchases of safety goggles or specs are not unusual for patients with traumatic emergencies or foreign bodies if the emergency is related to a regular activity. Otherwise, you have either a new patient you can schedule for a routine exam once the emergency is resolved or perhaps an existing patient who may be behind for their annual exam.
Opportunity to Develop Loyalty
Loyalty is very high with these patients. Not only did you address an urgent problem when they needed you, but the relief you provided gave them great confidence in your skill and availability. They really understand that they can count on you. They are some of the most grateful patients you will ever encounter. Not only will they stay on as loyal patients; they will refer family and friends and describe you as the “best” doctor. About 30 percent of my emergency patients were new patients, representing a very significant source of new patient growth.
Probably Already Have Instrumentation Needed
Most emergencies can be handled with standard equipment and diagnostic drops already in the office. But you should keep the following on hand: sterile needles, forceps, eye spud and an alger brush.
Create Policy on When and Whom to Refer To
When I was in practice, I was able to care for most emergencies myself. Patient cases that are sent to the emergency room included penetration of the globe (I never witnessed this) or pupillary abnormality associated with an eye turn (aneurism) or a severe injury that risked visual loss (very unusual). It is very rare that I would have to send a patient to a specialist or an ER. As a general rule of thumb, I advise steering them away from an ER and toward a specialist unless you have an eye hospital in the area–or if the emergency is neurological or systemic in nature. Those emergencies are rare, but we have to always be ready for them.
Publicize Your Emergency Services
Inform every patient you see that you are available for emergencies, and devote a portion of your web site to listing your emergency care services. Your expertise at emergency care also should be posted in your office in the reception area such as with a small sign at the front desk. You also should list that you provide emergency services on your business cards. Have staff mention your emergency eyecare services to patients, as well. At the same time, seek out referrals by establishing relationships with family practitioners and pediatricians.
Six Steps to Eyecare Emergency Readiness
1. Prepare staff. Staff must identify emergencies, know what questions to ask, calm the patient and get them on the appointment calendar immediately. They should inform the doctor just as the patient arrives or if they have any questions while they still have the patient on the phone. Train staff to make sure emergency patients are made comfortable as soon as they check in for their appointment.
2. Stock supplies. Keep sterile gauze, surgical tape and therapeutic drops on hand at all times.
3. Call patient.Thedoctor should callthe patient the evening after they leave your office to check on them.
4. Schedule follow-up visit. Always schedule a follow-up visit, and continue to see the patient until their condition is fully resolved.
5. Know referrals. Have a list of specialists for each area of emergency (cornea, retina, neuro, etc.) for immediate referral in the event that you need it. Make certain that each of these specialists can accommodate patients immediately upon their referral or after hours if necessary.
6. Be available. Make sure your patients can reach you 24 hours a day. Have an answering service or an emergency phone number on your office voicemail when patients call after hours.
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Jeanmarie Davis, OD, recently joined Alcon’s Global Performance Development department as manager, technical, Global Performance Development. To contact her: drdavis2020@yahoo.com.
