Surgery Prioritization Strategy: Typical Ophthalmic Procedures

Download the surgery prioritization list (PDF) and list of CPT codes (PDF)

As surgery resumes across the country, many physicians are wondering which procedures will come first. With input from ophthalmic subspecialties, the Academy has produced new guidelines for prioritizing surgical cases by diagnosis as surgery resumes. Use this guidance as a tool to persuade insurance carriers, health care systems and facilities that eye cases are more than elective and warrant prioritization.

Surgery performed in an ambulatory surgery center (ASC) setting will likely have less impact on medical resources than on a hospital outpatient department, and inpatient work and may follow locally modified start rules. In general, ophthalmic surgery has some features that reduce demand on resources such as:

• Nearly all are outpatient.
• Most can be done with sedation anesthesia only.
• There is no blood demand.
• They involve small operating teams.

This list below is not exhaustive. Some diagnoses that are not listed would fit where similar conditions are listed. This prioritization list is based upon the timing rules for each description listed above. They are suggestions only. Individual circumstances always take precedence. The Academy will update this list regularly as conditions change.

Updates:

• The listings for pediatric and adult cataract in the semi-elective section were updated with new information. (8:10 a.m. PT, May 13, 2020)
• The listing for corneal transplant in the semi-elective section was updated with new information. (8:40 a.m. PT, May 13, 2020)

Emergent

Definition: If delayed would present a substantial threat to visual function.

• Endophthalmitis
• Intraocular foreign body
• Open globe
• Cantholysis/canthotomy
• Orbital cellulitis
• Orbital cellulitis/abscess
• Acute dacryocystitis
• Canalicular lacerations
• Traumatic extraocular muscle tear
• Compressive optic neuropathy
• Orbital decompression for vision loss
• Orbital abscess
• Anterior chamber tap
• Angle closure glaucoma

Urgent

Definition: If delayed beyond several hours to several days, would present a substantial threat to visual function.

• Temporal artery biopsy
• Retinal detachment - macula on
• Exam under anesthesia for tumor, infection, retinal detachment
• Corneal foreign body
• Ocular surface reconstruction with progressive melting, impending perforation, Descemetocele
• Nasolacrimal duct probe for infection
• Lid, facial lacerations
• Orbital, facial fractures
• Retrobulbar injection for pain
• Neonatal dacryocystocele
• Lid Lacerations
• Orbital Fractures
• Tarsorrhaphy for corneal compromise
• Orbit/eyelid/intraocular malignancy
• Enucleation for pain, infection, tumor
• Evisceration for pain, tumor
• Exenteration for infection
• Optic nerve sheath fenestration
• Anterior chamber washout for hyphema
• Remove/revise aqueous drainage implant
• Infantile glaucoma
• Flat anterior chamber
• Phacomorphic glaucoma
• Glaucoma, uncontrolled

Semi-urgent

Definition: If delayed beyond several hours to several days, would result in significant to permanent compromise to visual function or intolerable limitation on daily activities.

• Infantile cataract
• Adult cataract unable to drive, work, fall risk or intolerable anisometropia
• Pediatric cataract at risk for amblyopia
• Intravitreal injection
• Brachytherapy
• Drain choroidal(s)
• Infantile ptosis
• Retinal detachment - macula off
• Proliferative diabetic retinopathy
• Proliferative vitreoretinopathy
• Macular hole
• Retisert placement
• Enucleation for melanoma
• Basal cell, squamous cell cancer of eyelids and conjunctiva
• Glaucoma procedures (all) if progressing
• Bleb leak
• Hypotony/cyclodialysis cleft
• Corneal biopsy for undiagnosed corneal ulcer
• Conjunctival biopsy for cicatrizing conjunctivitis
• Ocular surface reconstruction
• Pediatric corneal transplant at risk for amblyopia
• Corneal transplant unable to drive or with pain

Semi-elective

Definition: Delay beyond six to 12 weeks would result in significant and potentially permanent functional compromise to form or non-life-sustaining function.

• Pediatric cataract – less critical for impact on amblyopia or ADL
• Childhood strabismus
• Adult cataract – less critical/disabling impact on ADL
• Corneal transplant – no pain, less critical/disabling impact on ADL
• Progressive pterygium
• Glaucoma with stable VF, nerve
• Infantile ptosis
• Epiphora
• Symptomatic entropion
• Adult strabismus with diplopia
• Epiretinal membrane

Elective

Definition: Any procedure for a medical condition that does not in the foreseeable future threaten life, limb and/or bodily function.

• Adult strabismus without diplopia
• Adult ptosis
• Blepharoplasty
• Ectropion