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OPHTHALMOLOGY Summary of Services and Availability (By Location)

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OPHTHALMOLOGY Summary of Services and Availability (By Location) UPMC | University of Pittsburgh Medical Center For Reference Only OPHTHALMOLOGY Summary of Services and Availability (by location) Please review the following Summary of Services and Availability by Location prior to making your selections. If a facility is specifically identified below as NOT having a privilege/service available, you will NOT be considered for that privilege at that individual facility. Any request made that is identified as not available at an individual site will be considered Not Applicable for that site(s), and will be identified as such on your final approved Delineation of Privileges form. Key “x” means Privilege is Available at that location. “C” means contractual arrangement restricts granting this privilege. “N/A” means Privilege Not Available at that location. Facility Codes: EAST=UPMC East Privilege Core Privileges X Consultation Privileges X BOTULINUM TOXIN INJECTIONS X TEMPORAL ARTERY BIOPSY N/A LACRIMAL APPARATUS (including emergency procedures) Excision of lacrimal gland and sac (including N/A drainage and exploration) Excision and destruction of lesion of lacrimal gland N/A or sac Dacryocystorhinostomy N/A Repair and plastic operation on lacrimal apparatus N/A Probing lacrimal tract-canaliculus X Insertion of canula X EYELIDS Blepharotomy – incision/drainage of X abscess/chalazion, cyst Removal of chalazion X Blepharorrhaphy-suture, Z-plasty X Blepharoplasty-ectropion and entropion X Blepharoplasty repair of dermatochalasis and X blepharochalasis Operation on the canthus X Operation on levator palpebrae muscle and tendon N/A Fasanella servat N/A Lateral canthal sling N/A Muller muscle recession X Tarsorrhaphy X Correction of ptosis X Trichiasis X Excision tumors X Skin grafts N/A Eyelash, eyebrow grafts N/A UPMC | University of Pittsburgh Medical Center For Reference Only OPHTHALMOLOGY Page 2 of 3 Privilege Epicanthus X CONJUNCTIVA Incision and drainage of conjunctiva X Excision of epithelioma, nevus, papilloma X Excision of ring of conjunctiva around cornea X Suture of conjunctiva X Plastic repair of conjunctiva X Excision of pterygium X Repair injuries X Debridement and grafting of burns X Correction of symblepharon X ORBIT Orbitotomy X Removal lesion of orbit X Enucleation or evisceration orbital contents X Repair eye socket or orbit X Insertion implant X Reinsertion of expelled or extended implant X Repair of ruptured globe X MUSCLES Resection of muscles X Enuclation or evisceration eyeball X Suture eyeball X Myotomy and tenotomy, ocular X Recession eye muscle X Resection of eye muscle X CORNEA AND SCLERA Pterygium removal with graft X Keratotomy X Keratectomy and destruction lesion X DSEK N/A Tattooing cornea N/A Keratoplasty N/A Sclerotomy including drainage and exploration N/A Sclerectomy and destruction of lesion N/A Scleroplasty and repair sclera N/A Repair injuries X Scleral patch graft N/A IRIS AND CILIARY BODY Trabeculectomy, including revision, repair of X wound leak, trabecolotomy, and goniotomy Cyclocryotherapy X Cyclophotocoagulation X Repair cyclodialysis X Iridotomy X Iridectomy and destruction of lesion X Glaucoma drainage device, including revision of X tube implant Canaloplasty X Stretching iris, synechialysis, posterior and anterior X UPMC | University of Pittsburgh Medical Center For Reference Only OPHTHALMOLOGY Page 3 of 3 Privilege CHOROID, ANTERIOR CHAMBER Excision, repair, separation, diathermy X Paracentesis anterior chamber X Evacuation and aspiration X LENS AND VITREOUS Vitrectomy, mechanical and manual, pars plana; X Anterior and posterior vitrectomy w/ anterior approach Injection of intravitreal therapeutics X Capsulotomy X Extraction of lens X CATARACT SURGERY Extracapsular X Intracapsular X Phacoemulsfication X IOL IOL removal X Primary and secondary implantation of Refractive X and Phakic IOLs PHOTOCOAGULATION Trabeculoplasty-SLT X Trabeculoplasty-ALT X Iridotomy, iridoplasty, gonioplasty X Endocyclophotocoagulation N/A Panretinal photocoagulation X Focal photocoagulation of retina X ANESTHESIA Retrobulbar or periorbital block X Local eyelid block X Moderate sedation X Trigger point injections X LASER Nd:YAG X Argon X Diode- 532 nm X Diode- 810 nm X Photo-Dynamic Therapy- 630 nm X Intralase X Excimer 193 nm- Refractive surgery of the cornea X (Lasik, PRK, and intrastromal rings) Treatment of retinal tear X YAG X Capsulotomy X Vitreolysis X Iridotomy X FLUOROSCOPY (Certificate Required) N/A Origin: 05/03/12 .
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