Eye Exams
VSP WellVision® Exam Components
In compliance with the clinical standards of the American Optometric Association and the American Academy of Ophthalmology, an eye exam should include, and is not limited to, the following components:
|
Components of a VSP WellVision Exam |
|
|
Case History |
|
|
Entrance Exams
|
|
|
Refractive Status Evaluation |
|
|
Ocular Health Assessment |
|
|
Assessment and Plan |
|
Appropriate evaluation and recording of data in each area outlined above is required. Refer to Exam Documentation for these requirements.
Patient Referrals
In some cases, to support the best possible health outcomes for your patient, you may need to refer your patient to their primary care provider or other eye care specialist. If you determine your VSP patient needs care coordination, please refer the patient to their medical insurance plan with a copy of your referral, including a relevant summary of your examination findings. Retain a copy of any referral correspondence in your patient’s records or file. To assist with this communication, we provide the optional Primary Care Physician Communication Form which may be accessed in the Forms Library section of the Administration area on VSPOnline.
Evaluation and Management Services
VSP covers evaluation and management services for patients who have Essential Medical Eye Care as part of their VSP plan. Please refer to Current Procedural Terminology (CPT) guidelines maintained by the American Medical Association (AMA) for additional information related to evaluation and management services.
Patients with Diabetes
The American Diabetes Association, American Optometric Association, and American Academy of Ophthalmology recommend that patients with diabetes receive an annual dilated eye exam. A dilated retinal eye exam is also a measure of clinical quality designated by the National Committee for Quality Assurance (NCQA).
In support of this standard of care, VSP highly recommends patients with diabetes receive a dilated retinal eye exam.
We recognize that at times there are good reasons for not providing a dilated exam. In those cases, medical record documentation of the rationale for not performing dilation is required. Examples include:
- Patient refused
- Dilated exam was performed within the last 12 months
- Patient scheduled dilation for a later date
- Patient is under the care of another practitioner
- Patient has a history of adverse or allergic reaction to mydriatic eye drops
VSP requires network doctors to share dilated or retinal eye exam results with the patient’s primary care provider (PCP) or the physician managing diabetes care. This communication not only ensures continuity of care but also highlights your role in the healthcare continuum and your involvement in the treatment of patients with diabetes and other health conditions. To assist you with this communication, we provide the optional Primary Care Provider Communication Form which may be accessed in the Forms Library section of the Administration area on VSPOnline.
Please refer to the HEDIS for Quality Measures section for additional information on VSP’s standards of care in diabetes.
Note:
Retinal imaging does not replace a dilated eye exam as the standard of care for a patient with diabetes.