Amniotic Membranes – When To Use Them and How To Bill For Them

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What is an amniotic membrane?

  • An amniotic membrane is the inner layer of fetal membrane.
  • The membrane has anti-inflammatory, anti-fibrotic, anti-angiogenic and anti-microbial properties.
  • An amniotic membrane is a healthy, intact, basal membrane on which the patient’s cells are able to proliferate.
  • It returns the ocular surface to healthy level2
Screen Shot 2016-05-11 at 1.24.45 PM
Image Source: Review of Ophthalmology

What ocular pathologies can amniotic membranes improve?

  • Screen Shot 2016-05-12 at 12.41.22 PMrecurrent corneal erosion
  • infectious keratitis/ulceration
  • Salzmann’s nodular dystrophy
  • superficial punctate keratitis
  • epithelial basement membrane dystrophy
  • neurotropic disease2

Who is a good candidate? Who is not a good candidate?

  • Any patient who has any of the aforementioned conditions is a potential candidate.
  • Patients with mild dry eye who can be treated with standard treatments (Restasis, Lotemax, ATs) are not ideal candidates.2
  • Treatment has been less successful in the following conditions:
  • mucous membrane pemphigoid (79 percent)
  • chronic Stevens-Johnson or Lyell’s syndrome (62 percent)
  • reconstruction of the conjunctiva and fornix (47 percent)
  • neoplasia of the ocular surface (33 percent)
  • primary and secondary limbal stem cell deficiency (32 percent)
  • physical trauma (30 percent)
  • chemical trauma (24 percent)
  • pterygium (8 percent)
  • recurrent epithelial erosions (5 percent)3

Patient Education

Patients should be educated on discomfort due to the size of the membrane and blurred vision during the healing process. Patients should also be placed on Restasis  and Lotemax TID while the membrane is on the eye. 2

Procedures for Application and Removal

Storage – can be stored in a refrigerator up to 3 months and a freezer up to 1 year.

Application:

  1. Rinse the device with saline when it arrives to prevent burning upon insertion.
  2. Hold the ring with your thumb and forefinger at the 6 o’clock position.
  3. Apply topical anesthetic.
  4. Have the patient look down, and apply the membrane to the superior conjunctival fornix.
  5. Have the patient look up and apply the membrane to the superior conjunctival fornix.
  6. Tape the temporal half of the upper eyelid closed to decrease movement and increase comfort.1
Patient should be seen daily until healing occurs!

Removal:

  • Approved to stay on the eye for a maximum of 8 weeks or until tissued has healed. Healing is usually completed between 1-2 weeks.
  • Membrane can be completely absorbed by cornea within 1 week, but plastic ring must be discarded.
  • Apply topical anesthetic.
  • Have the patient look up and lift the lower edge.
  • Apply a gentle pressure to the superior lid in a downward motion.
  • Preservative free ATs can be used to improve comfort.1

Billing and Coding for Amniotic Membranes

Commercials carriers:

  • Bill procedure code 65778
  • Bill material code V2790

Medicare:

  • Only need to bill procedure code V2790 (Reimbursement for supplying the lens is included in payment for the procedure)1

If you have any experience with or questions about amniotic membranes, please leave them in the comments below!

NEWGRADOPTOMETRY.COM DOES NOT PROVIDE MEDICAL ADVICE. Any and all information found on NewGradOptometry.com is intended as a general resource only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis, or treatment and should not be relied on to make decisions about your health or that of your patients. It is not intended to be patient education and does not create a patient-physician relationship. Never disregard professional medical advice or delay seeking it because of something you have read on NewGradOptometry.com. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your doctor or dial 911.
© 2016 NewGradOptometry, LLC. All rights reserved.

Sources:

1. Luong, Paul D., Edward S. Bennett, OD, Stephanie L. Woo, OD, and Raymond J. Brill, OD. “The Role of Amniotic Membrane Transplantation.” The Role of Amniotic Membrane Transplantation. Contact Lens Spectrum, 1 Mar. 2016. Web. 12 May 2016. <http://www.clspectrum.com/articleviewer.aspx?articleID=113936>.

2. Rodriguez, Brandon, MD. “Using Amniotic Membranes for Dry Eye Patients.” Using Amniotic Membranes for Dry Eye Patients. Ophthalmology Management, 1 Nov. 2014. Web. 12 May 2016. <http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=111777>.

3. Stephenson, Michelle. “Newsletters.” Review of Ophthalmology® Treatment Options with Amniotic Membrane. Review of Ophthalmology, 5 Nov. 2015. Web. 12 May 2016. <http://www.reviewofophthalmology.com/content/t/therapeutics–external_disease/c/58142/#sthash.FEIdRVjB.dpuf>.

About Courtney Dryer

Courtney Dryer
Courtney Dryer is a 2011 graduate of SCO. She opened 4 Eyes Optometry in her hometown of Charlotte, NC in February of 2013. After 5 years, the practice name was changed to Autarchic Spec Shop to renew the practice's commitment to independent optometry. In addition to consulting with new graduate optometrists on start-up practices, she contributes regularly to New Grad Optometry and has guest blogged for Invision Magazine. The unique design of her boutique practice was featured in Women in Optometry. In 2015, Vision Monday named her a Rising Star, and one of the most influential women in optical.

One comment

  1. Matthew Geller

    Thanks for this, Dr. Dryer. I’ve only fit one Prokera and it wasn’t hard at all. Have you ever put one on before? Surprisingly, it’s not too bad.

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