Tear Osmolarity Testing Protocol

The check boxes indicate sections to include in your Tear Osmolarity Testing Protocol. If you would like the section included in your custom protocol, please check the box.

December 10, 2018

New Patient

Number of symptoms using dry eye questionnaire
Score on dry eye questionnaire =

Returning Patient

Prior DED Dx with hyperosmolarity > ( mOsm/L) ( within months ) from prior tear osmolarity test.
Number of symptoms using dry eye questionnaire
Score on dry eye questionnaire =

Other

Notes:
Notes:
** Without a current DED sign or symptom, tear osmolarity testing is considered a screening tool and may not be reimbursed. For these uses, please consider adding notes that clarify the use of an Advanced Beneficiary Notice (ABN) or include a note that states - 'Do not bill. Included in Global Fee'.
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