Print | ShareCPT Code: 92060 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Sensorimotor Examination with Multiple Measurements of Ocular Deviation
Category
Special Ophthalmological Services
Description
A sensorimotor examination detects, assesses, monitors, and/or manages strabismus and oculomotor conditions including, but not limited to esotropia, exotropia, and hypertropia.
This Medicare carrier does not have a local coverage determination (LCD) for a sensorimotor examination. The policy presented is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
A sensorimotor examination detects, assesses, monitors, and/or manages strabismus and oculomotor conditions including, but not limited to esotropia, exotropia, and hypertropia. These conditions can have important visual, developmental, and/or systemic implications. The sensorimotor examination is used to help diagnose and/or treat these conditions, in follow-up to detect improvement, deterioration, or stability, and also to determine the effect of optical correction on the strabismic condition. Information from the sensorimotor examination can be used to plan medical, optical and surgical treatments.
The examiner utilizes a series of vertical and horizontal prism bars or individual handheld prisms to measure ocular deviation in a sensorimotor examination. Ocular deviations, such as strabismus, are seen when the eyes position themselves to each other on axes different from what is needed. Ocular deviations can occur in the horizontal or vertical plane. The eyes may move in toward each other (convergent) or away from each other (divergent). One eye (monocular) or both eyes (binocular) may be affected. The deviation may be observed to be the same no matter what direction the eyes are looking (concomitant) or to vary depending on where the eyes are looking (nonconcomitant). These deviations can be caused by ocular muscle anomalies, trauma or disease, or neuromuscular damage. The patient is asked to focus on a distant or near object in varying locations. An occluder may be alternately used to cover one eye while testing the other. Multiple measurements are taken and interpreted and a report is prepared.
A sensorimotor examination is used to detect, assess, monitor, and/or treat strabismus and other oculomotor conditions. Follow-up sensorimotor examinations are used to detect improvement, deterioration, or stability, and to determine the effect of an optical prescription on the binocular vision disorder.
- Constant or intermittent
- Variable or constant
- Comitant or non-comitant
- Alternating or non-alternating
2. Quality of fixation of each eye, separately and together
- Whether there is associated ptosis and/or abnormal head position
- If nystagmus is present
- Determination of angle of strabismus by prism and cover test, Maddox rod test, and corneal reflection of light, with or without prism
3. Testing ocular movements
- Duction/monocular rotations
- Versions/conjugate ocular movements
- Disjunctive movements
- Convergence
- Divergence
4. Sensory exam:
- Stereopsis testing by reandom dot stereograms
- Suppression testing by Worth four dot test
- Fusion potential by the red filter test
ICD-10 Diagnosis Codes
ICD-10 Codes Description
G52.7
Disorders of multiple cranial nerves
G52.9
Cranial nerve disorder, unspecified
H52.521 - H52.523
Paresis of accommodation
H53.2
Diplopia
H53.30
Unspecified disorder of binocular vision
H05.121 - H05.123
Orbital myositis
H50.011 - H50.032
Monocular esotropia
S02.3XXA - S02.3XXS
Fracture of orbital floor
1. The medical record should legible and clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the test. If the medical necessity for a sensorimotor examination is not specifically documented, the rationale for ordering the test should be easily inferred from the patient’s medical record.
2. An order for the test must be part of the medical record. Superbills, routing slips, etc. are not a part of the medical record.
3. The interpretation and report must contain the following:
- Clinical findings — pertinent findings regarding the test results
- Comparative data — comparison to previous test results (if applicable)
- Clinical management — how the test results will affect management of the condition/disease
4. The medical record must be made available to Medicare upon request.
1. Report a sensorimotor examination with CPT code 92060. This is a bilateral diagnostic test, therefore no modifiers are required. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. A sensorimotor examination requires general supervision by the optometrist/ophthalmologist. This means the doctor maintains direction and control of the diagnostic test — but his or her presence is not required in the room or the office while the test is performed.
3. An eye examination may be reported on the same day if it is medically necessary.
4. According to the CPT Codebook, a basic sensorimotor examination is a required service component for a comprehensive ophthalmological examination. It is an incidental component of the eye exam and may not be reported separately or reimbursed. Abnormal findings (e.g. tropias or phorias) should be noted in the basic sensorimotor exam to document the medical necessity required to order and perform a quantitative sensorimotor examination.
This Medicare carrier has no specific utilization guidelines for quantitative sensorimotor examination; however these tests are reimbursed at a frequency based on medical necessity. Like most diagnostic tests, follow-up testing may be medically necessary in any of the following clinical circumstances
- New symptoms
- Clinical signs of disease progression
- Unreliable prior test results
- Change in the treatment plan
In the absence of specific utilization guidelines, optometrists and ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of ophthalmic practice.