CPT® Code 0445T

1. Indications

The procedure associated with CPT® Code 0445T is indicated for patients requiring ongoing medication delivery to the ocular surface through a drug-eluting ocular insert. The specific indications for this procedure include:

• Chronic Ocular Conditions Patients suffering from chronic ocular conditions that necessitate sustained medication release, such as glaucoma or dry eye syndrome.
• Medication Management Situations where continuous medication dosing is required to manage symptoms effectively and improve patient outcomes.
• Replacement of Existing Inserts Cases where an existing ocular insert needs to be removed and replaced to ensure the efficacy of the treatment regimen.

2. Procedure

The procedure for the subsequent placement of a drug-eluting ocular insert involves several detailed steps to ensure proper insertion and patient comfort. The steps are as follows:

• Step 1: Measurement of Intercanthal Distance The healthcare provider begins by measuring the intercanthal distance to determine the appropriate size of the ocular insert required for the patient. This measurement is crucial for ensuring that the insert fits correctly and functions as intended.
• Step 2: Anesthetic Application A topical ophthalmic anesthetic is instilled in the eye to minimize discomfort during the procedure. This step is essential for patient comfort and cooperation during the insertion process.
• Step 3: Upper Eyelid Retraction The upper eyelid is manually retracted to provide access to the upper fornix, where the insert will be placed. This retraction allows for a clear view and easier manipulation of the insert.
• Step 4: Insertion into Upper Fornix The drug-eluting ocular insert is carefully placed in the upper fornix. The provider ensures that the insert is positioned correctly to allow for optimal drug release.
• Step 5: Lower Eyelid Retraction The lower eyelid is then retracted, either manually or with the assistance of a scleral depressor, to facilitate the placement of the lower half of the insert in the lower fornix.
• Step 6: Final Positioning The provider ensures that a portion of the insert is visible in the medial canthus, which is important for patient management and monitoring of the device.
• Step 7: Patient Instruction After the successful placement of the insert, the patient is instructed on the proper care and management of the ocular insert, including how to handle any slight displacements that may occur during normal activities.

3. Post-Procedure

Post-procedure care following the placement of a drug-eluting ocular insert includes monitoring for any immediate discomfort or complications. Patients are advised to follow the care instructions provided by the healthcare provider, which may include guidelines on how to clean the area around the insert and what to do if the insert becomes displaced. Regular follow-up appointments may be scheduled to assess the effectiveness of the medication delivery and to ensure that the insert remains properly positioned. Patients should also be educated on signs of potential complications, such as increased irritation or changes in vision, and instructed to seek medical attention if these occur.