2/16/2016

GROWING YOUR PRACTICE Regenerative Therapy

OCULAR SURFACE RECONSTRUCTION  Human cellular and tissue-based membrane

Derived from human amniotic tissues
WITH 
 Placenta is a rich source of undifferentiated stem cells
AMNIOTIC MEMBRANE THERAPY  Tissue has unique immune privilege
 Growth factors

Craig Thomas, O.D.  Anti-inflammatory properties

3900 West Wheatland Road  Suppresses pain
Dallas, Texas 75237  Application procedure is a transplant and human to
972-780-7199 human tissue transplants are called allografts
thpckc@yahoo.com
 When successful, the amniotic membrane functions as a
scaffold for ocular tissue repair and regeneration

Amniotic Membrane Allografts Clinical Indications

BioDOptix Amniotic Membrane
 Tissue stabilization is
accomplished by a dehydration
technique
PROKERA Amniotic Membrane
 Tissue stabilization is
accomplished by a
cryopreservation technique
 Self-retaining biologic corneal
bandage
 Amniotic membrane is fastened to
a thermoplastic symblepharon
ring
 Allograft device is designed to
maintain space in the orbital
cavity and to prevent closure or
conjunctival adhesions
 “Amniotic membrane placement may be indicated
in the treatment of ocular surface disease when
medical management fails, is not tolerated, or
is contraindicated”
 The goal of amniotic membrane therapy is
ocular surface reconstruction
 Moderately-severe and severe dry eye syndrome
 Corneal edema
 Band keratopathy
 Chronic conjunctivitis
 Anterior basement membrane dystrophy

Moderately-Severe Dry Eye Amniotic Membrane Therapy

Dry Eye Workshop Classification
 Level 3 Severity
 Moderately-severe
to severe symptoms
 Conjunctival epithelial
desquamation
 Corneal epithelial
desquamation • Same patient on Jan 26, 2016 • Same patient after 2 days of
• Collagen plugs 11/14 and 8/15 therapy with BioDOptix extracellular
 Filamentary keratitis • Pulse therapy with steroids membrane allograft
70-year-old woman with adult rheumatoid
arthritis. Moderately-severe corneal and • Using Lumigan for glaucoma • Complete resolution of corneal and
conjunctival epitheliopathy – Nov 2014 • Using Oasys unpreserved tears conjunctival epitheliopathy

1
 2/16/2016

Chronic Postoperative Corneal Edema Amniotic Membrane Therapy

Same patient 4 days

after placement of a
BioDOptix dehydrated,
extracellular membrane
allograft

Membrane placement
generally can be
maintained with a soft
bandage contact lens

• 72-year-old man 5 years after complicated cataract surgery in the right eye Allograft typically
• Epithelial disruption in a linear-shaped band at 8:00 revealed with fluorescein incorporates into the
• Patient suffers from chronic foreign body sensation and hyperlacrimation tissues of the ocular
• Patient has been to three different ophthalmologists in the past 5 years surface in 4-7 days
• Significant improvement in symptoms after 2 days of amniotic membrane therapy

Neurotrophic Corneal Ulcer Amniotic Membrane Therapy

PROKERA SLIM
amniotic membrane
insert device is placed
under the eyelids
between the eyeball
and the eyelid

Amniotic membrane
graft is fastened to an
ophthalmic conformer
(i.e., thermoplastic
• Neurotrophic keratopathy is a degenerative disease of the corneal epithelium resulting symblepharon ring)
from impaired corneal innervation
• A reduction in corneal sensitivity is the hallmark of the disease and is responsible for
producing epithelial keratopathy, ulceration and perforation

Placement Procedure Billing and Coding

 CPT code 65778

 Medicare fee schedule in Dallas, Texas
 Participating provider - $1,464.30
 Non-participating provider - $1,391.09
 Limiting charge amount - $1,599.75

 Bilateral surgery modifier (-50) applies

 Zero day global period
 Amniotic membrane placement procedure can be
repeated monthly if it is reasonable and
• Placement of lid speculum to keep the eyelid open until the membrane is placed medically necessary
• A speared sponge is used to dry the ocular surface and remove loose tissue