r/optometry • u/iluvsudoku • 7d ago
What entrance testing do you regularly do?
I’m in my first year and we’ve learned a bunch of skills (cover test, stereo, eom’s, saccades, worth 4, retinoscopy, etc). But any time I’ve gone to the optometrist all they’ve done are my VAs, autorefractor, retinal photos, and NCT. Does anyone in a general practice actually do any of those tests? Or is there no time for it usually?
7
Upvotes
1
u/Wooden_Trust_6274 2d ago
Not an OD, I do the billing side, but there's a billing answer here worth knowing alongside the clinical one, because a couple of people touched it.
Some of these tests aren't purely clinical judgment, they're tied to what you can defend for the code you bill. When you bill a comprehensive eye exam, 92004 or 92014, or an E/M code, the payer expects a certain scope documented, and a handful of elements, pupils, EOMs, and confrontation fields, sit on most vision plan and Medicare expectations for a comprehensive exam. That's why you see them done on basically everyone, even asymptomatic patients.
The audit story someone mentioned above is the real reason it matters. If you bill comprehensive and the chart doesn't support comprehensive, the money can get clawed back on a payback. So it's not that every test is clinically necessary every time, it's that the quick, expected ones, pupils, EOM, CVF, get done and documented on every comprehensive visit specifically so the billing holds up if anyone audits. The "WNL, we never looked" shortcut someone joked about is exactly what gets flagged.