Pediatric ophthalmologists work closely with orthoptists.  An orthoptist is like a highly specialized nurse covering the fields of amblyopia and strabismus.

Pediatric ophthalmologists and orthoptists are specially trained to measure, or coax-out, three (3) extremely important parts of the eye exam of a child that may seem less important on a comprehensive eye exam of a healthy adult: 1) visual acuity, 2) refraction and 3) ocular alignment. Misalignment of the eyes is called “STRABISMUS.”  Deficient refractions and ocular alignment in children less than ten years of age commonly leads to potentially permanent vision impairment called “AMBLYOPIA.”  Amblyopia is deficient brain learning of vision resulting in decreased visual acuity.  Young children are less able to cooperate with acuity and alignment measurement than most adults, but they are at high risk of amblyopia.

Vision Exams: These are routine exams that may be covered by a family’s added “Vision Plan” which usually includes some discounted coverage for spectacles and / contact lenses.  The diagnoses covered by Vision Exams includes: myopia (nearsightedness- 367.1), hyperopia (farsightedness-367.0), astigmatism (367.2), presbyopia (367.4) and should also include anisometropia (367.31).  Vision plans do not cover payment for eye diseases.  Payment on vision plans is usually time-limited- either one exam per year or one exam every other year.  Procedure codes for initial vision exams include 92002 and 92004 and whereas subsequent (within the past three years) is covered by 92012-92014.

Determining the refractive state of the eye is covered by procedure code 92015.

Contact Lenses: One of the worst forms of treatable pediatric blindness is deprivationl amblyopia (368.02) due to monocular infantile cataract (743.3).  The good news is that early detection combined with prompt surgery, contact lense refractive rehabilitation and patching can yield good vision!  The bad news is that many children have gone blind due to delayed, or denied coverage of aphakic contact lenses.  Delivery and fitting of therapeutic contact lenses is covered by 92070.  The American Academy of Ophthalmology strongly warns against denial of prompt coverage of contact lenses in the treatment of high anisometropic amblyopia (368.03 – 367.31).

Photoscreening is a new procedure that allows the pediatrician to estimate refractive error and ocular alignment.  It should be covered by procedure code 99174.  About 5% of children will have a harmful refractive error or strabismus and therefore have a light crescent or asymmetric light image in the pupil of one or both eyes.  Leukocoria is a light colored pupil image diagnosed with 360.44.

Pediatricians should routinely screen school aged children, and cooperative preschoolers with monocular (patched) acuity screening; this should be covered by procedure code 99173.

An examination of the eye, particularly in young or uncooperative children, is covered by procedure code 92018 (complete) and 92019 (limited).

Medical exams:  Examinations for medical conditions of the eye are covered by Evaluation and Management (E/M) codes.  New or renewed exams are covered by 99201-99205 depending on the complexity of the exam and number of diseases diagnosed.  Subsequent or follow-up exams are covered by 99212-99215- patients should be covered by medical exams as frequently as is medically necessary- not just once per year.  When the medical exam is the result of a consult requested by another health professional, codes such as 99241-99245 may be used.  Medical insurance usually does not cover refractive conditions such as myopia, hyperopia, astigmatism or presbyopia.

A Sensorimotor exam with multiple measurements of ocular deviation with interpretaion and report is epitomized by the cooperative evaluation by orthoptist and pediatric ophthalmologist in a child or adult with strabismus.  The ocular alignment at distance and near and in various fields of gaze is determined along with measurements of the binocular vision. The ocular alignment in adults may also be graphically monitored on a Hess Chart. The Sensorimotor exam is covered by 92060.

Orthoptic therapy and training is covered by 92065.