Coding & Reimbursement

Clarifying Quantitative Sensorimotor Exams

By Suzanne L. Corcoran, COE

Quantitative sensorimotor exams have been available to ophthalmologists for many years, and continue to be valuable. However, questions about reimbursement still persist; this Q&A will attempt to clear up the confusion.

Q. What is a sensorimotor exam?

A. A basic sensorimotor exam evaluates ocular range of motion to determine if the eyes move together in the various cardinal positions of gaze (12:00, 1:30, 3:30, etc). This exam element is commonly noted as ocular motility, or extraocular muscles (EOM), in the chart note. A normal range of motion is often noted as "full" or "within normal limits."

Documentation of alignment, usually in primary gaze, is often noted as orthophoria (ortho) in older children and adults. For pediatric patients, "CSM" for "central, steady, maintain" and "F&F" for "fix and follow" are often used to denote both visual acuity and gross motility. Abnormal conditions are noted as phorias or tropias.

CPT lists basic sensorimotor exam as a required exam element of a comprehensive eye exam (920×4); it is an incidental component and not separately reimbursed. A quantitative sensorimotor examination, utilizing prisms to measure ocular deviation, is a more extensive exam and may be separately billable.

CPT describes this diagnostic test as 92060, Sensorimotor examination with multiple measurements of ocular deviation (e.g., restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure). Fundamentally, this test requires the clinician to assess both eyes (i.e., bilateral); it should not be billed per eye. Pertinent diagnoses include but are not limited to: diplopia, exotropia, esotropia, hypertropia and paralytic strabismus.

The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) issued a position statement in 1999. They state, "Sensorimotor eye exam includes measurement of ocular alignment in more than one field of gaze at distance and/or near, and inclusion of at least one appropriate sensory test in patients who are able to respond." Measuring only primary gaze at distance would not satisfy the requirements. You should include ocular alignment measurements in more than one field of gaze.

According to sources at AAPOS, primary gaze at distance and near for accommodative esotropia would satisfy the criteria.

Examples of sensory function testing include Worth 4 dot, Maddox rod, and Bagolini lenses. The assessment of sensory function is complementary to the evaluation of the motor function as the term "sensorimotor" implies. It is no less important and an essential part of the service.

Q. How is the sensorimotor exam documented in the patient's medical record?

A. An order for the test should be noted in the chart. Test results for motor function are typically documented in a "tic-tac-toe" format to represent different fields of gaze. Results of the sensory function test are noted, too. Examiners note how many of the stereo rings on the Titmus Fly test are correctly observed by the patient and whether or not the patient appreciated the three-dimensional appearance of the fly's wings. A positive stereo test on a nonverbal patient might be represented by the patient's attempt to touch or pick up the fly's wings. Results of a Worth 4 dot often note which lights were seen. An interpretation of the test results and the effect on the patient's condition and course of treatment satisfy the interpretation requirements.

Take care that the notations for the test are clearly identifiable and distinct from the office visit notes (e.g., stamp, boxed entry, separate page, etc.).

Repeated testing is indicated when medically necessary for new symptoms, disease progression, new findings, unreliable prior results or a change in the treatment plan. In general, additional testing is warranted when the information garnered from the eye exam is insufficient to adequately assess the patient's disease.

So, if a patient has a history of accommodative esotropia and the basic sensorimotor exam reveals an unstable or worsening condition, the more extensive test is justified. We would not expect a claim for a stable patient who presents with no complaints or one with a controlled condition. OM