Are you getting an EYE EXAM or just a VISION TEST?
IF YOU HAVE EVER HAD A GLASSES EXAM THE SAME YEAR AS A CONTACT LENS EXAM WITHOUT A SIGNIFICANT PRESCRIPTION CHANGE, YOU WASTED YOUR TIME AND MONEY BECAUSE THEY REPEATED THE 92004 AND 92015 IN ORDER TO DO THE 92310 BECAUSE A CONACT LENS FIT IS NOT A STAND ALONE SERVICE.
Most people call a it a routine eye exam: for wellness eye health and vision (no disease or condition) this is a service defined federally by CPT (Current Procedural Terminology), the minimum requirements in the state you reside (for IL click here), and the liberties taken by the practice because it is largely unregulated. A 21-point 92004 (92014 if established) is “a medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits”. It is inherently a medical procedure; and should be billed to medical insurance if a medical condition is found. Most offices will allow one “wellness” visit before informing a patient that due to a chronic condition or disease s/he will be eligible for office visits under medical insurance but wellness exams are not appropriate for people who are followed for chronic conditions. Once the reason for a visit changes from comprehensive wellness to medical in nature the service changes to a “medical office visit” ranging in complexity depending on the elements of the exam (99211 to 99215).
The glasses prescription is a separate procedure, often bundled by the office or insurance plan with the 92004 but never bundled with a “medical office visit”; it is a 92015: Refraction. Seldom is this service parsed because it cannot meet the standards for an eye exam as a service without also having an eye health exam. Yet another procedure done during a visit is a contact lens fitting: 92310. This procedure is not a stand-alone procedure either; it requires the wellness or “medical office visit” and refraction to even be performed. That’s why our doctors advise you to have them done at the same visit: to save you time and money. Dozens of occasions a month, our doctors find that someone has been misled by definitions of exams: glasses exam vs. contact lens exam. There is no such thing as a contact lens only exam! It does not exist, just like a refraction only service cannot exist; they are falsities perpetuated by the uneducated.
In other words: if you see a nurse or technician, have a test done, but never get evaluated by the doctor (definition of an office visit); then you cannot get a prescription because it would be malpractice for the doctor to prescribe anything without evaluating you. Most often, people believe that the comprehensive part of the comprehensive exam is nothing more than the vision test (refraction). What makes it comprehensive are the four parts of an eye exam: a complete history, objective measures of the eyes, physical examination inside and out of the eyes, and functional vision testing.
If you’ve ever had an exam that didn’t include a complete history and detailed physical examination, you may want to reconsider where you’re getting your medical eye exam. The hard part is how does one know if these are done or not? The answer is incredibly simple: if you are offered an exam slot option more often than every 20 minutes there simply isn’t time to do all four parts of the exam, if they don’t ask questions then they did not take a history, and if they don’t spend more than a minute looking at your eyes with multiple tools (light, occluding paddle, microscope) then you probably are not getting a quality evaluation of your eye health. Lastly, are you getting this eye exam with a medical professional at a discount because of insurance, or are you seeing this doctor for a “$55 exam”, “$29 exam”, or “free exam with the purchase of glasses”. What other doctor would we see for next to nothing, and why would we want to be seen by a professional that doesn’t value the service s/he provides?
There are quality eye doctors providing quality exams all across the state (and nation), even those within corporate settings that offer a cheap exam. It is difficult not to be focused nearly 100% on the vision test (refraction), but if that is all your doctor looks at then you are getting a great disservice. Our doctors tell us that the difference between the places that are owned and operated by a doctor vs. someone with money to invest in an industry is a difference in quality: that of the equipment, dedication to preventative eye care and eye health (not just vision), and quality time devoted to patient history (medical, ocular, family, social, and reasons for the visit to the eye doctor so they can help you experience life better).