Frequently Asked Questions for Optometrists

If you are a Member of ACBO and practice the accepted principles of behavioural optometry then you are able to describe yourself as a "behavioural optometrist".
The matter of "children’s optometrist" is less clear. You would need to be able to demonstrate that you have experience and particular knowledge and skills in this area. See the discussion below.
The Optometry Board and AHPRA Guidelines for advertising state the following: 

Optometrists are not permitted to:

"...use words, letters or titles that may mislead or deceive a health consumer into thinking that the provider of a regulated health service is more qualified or more competent than a holder of the same registration category (e.g. 'specialising in XX' when there is no specialist registration category for that profession)"

"While the National Law protects specific titles, use of some words (such as 'specialises in') may be misleading or deceptive as patients or clients can interpret the advertisements as implying that the practitioner is more skilled or has greater experience than is the case.

These words should be used with caution and need to be supported by fact. Words such as substantial experience in’ or ‘working primarily in’ are less likely to be misunderstood as a reference to endorsement or specialist registration."

You cannot refer to yourself as a "specialist" under current law and guidelines.

The Optometry Board Guidelines for advertising state the following:

6.2 Prohibited advertising under the National Law

Section 133 of the National Law prohibits advertising that:

  • is false, misleading or deceptive or is likely to be so
  • offers a gift, discount or other inducement to attract a user of the health service without stating the terms and conditions of the offer
  • uses testimonials or purported testimonials
  • creates an unreasonable expectation of beneficial treatment, and/or encourages the indiscriminate or unnecessary use of health services

Important Note:

This information is provided as general information only and ACBO does not advise or endorse any particular course of action. You will need to read the AHPRA Guidelines and National Law and make your own judgement about your use of particular terminology, or seel your own legal advice before proceeding. AHPRA may impose penalties and sanctions for optometrists who breach legislation and guidelines.

Medicare Schedule Item 10943 - Children’s Vision Assessment

Introduction

In the course of standard optometric assessment of a child between the ages of 3 and 14 (inclusive) initial testing may reveal the presence of one of more of the following:

  • Accommodative dysfunction
  • Binocular vision dysfunction
  • Ocular motility dysfunction
  • Vergence dysfunction

To confirm the diagnosis, establish the nature and severity of the dysfunction and associated conditions, or establish a treatment regime, it would be necessary to provide further testing, which may include assessment of:

  • Accommodation
  • Ocular motility
  • Vergences
  • Fusional reserves
  • Cycloplegic refraction

When further testing is carried out the optometrist may bill the patient an Item 10943, in addition to any other Medicare Optometric Schedule item number other than 10916, or 10921 to 10930.

This Item 10943 is only payable once in a 12 month period.

Guidelines

Typically Item 10943 will be billed together with an “initial” examination by an optometrist of a patient. Usually this would be one of:

  • Item 10900 (comprehensive initial examination)
  • Item 10905 (referred comprehensive initial examination)
  • Item 10907 (comprehensive initial examination by another practitioner within 24   months of a previous comprehensive consultation
  • Item 10912, 10913, 10914 (other comprehensive consultation)

It may also be billed in association with an Item 10918 for a patient previously seen in the practice, when a dysfunction becomes apparent and further assessment is required. However, when you consider there is a significant change of visual function, Item 10912 can be billed instead of 10918; or if you consider there are new signs or symptoms, you can bill an Item 10913 instead of 10918.

The item 10943 is intended to be used for additional testing of an accommodative etc dysfunction. As such ACBO members should consider their minimum protocol of routine testing to detect the possibility of a dysfunction, and which additional tests they would then employ to further elucidate the diagnosis, and determine treatment. For example, standard optometric protocol for detection of an accommodative dysfunction might include two of the following test probes:

  • Near retinoscopy,
  • fused cross cylinder,
  • plus and minus to blur,
  • monocular amplitude of accommodation (push up or minus lens),
  • flipper testing of accommodative facility.

Once the possibility of an accommodative dysfunction has been detected by the use of two tests, any further testing would be covered and billed under Item 10943.

Similarly, standard cover and/or phoria testing may indicate the possibility of a binocular dysfunction, and then assessment of vergences, fusional reserves, vergence facility etc would be billed under Item 10943.

Also, testing of ocular motility with your initial protocol (which might include some or all of tests of NPC, pursuits and saccades) could lead to the necessity to employ further testing such as near-far-near, an NSUCO (Maples-Ficklin) grading of pursuits and saccades, or Developmental Eye Movement test (DEM). Any such further testing should be billed under Item 10943.

In principle, one to two tests of your initial testing protocol should be sufficient to detect the possibility of a dysfunction, and any further testing would constitute Item 10943.

The Optometrists’ Association Australia letter regarding this item states: “These procedures must be additional to the testing routinely performed by the optometrist”. Behavioural optometrists commonly carry out extensive testing of accommodative and vergence function, but in the opinion of the author are just as entitled to mentally divide testing into standard assessment, in the same way many non-behavioural optometrists provide minimal standard testing of these functions, and extra assessments. To suggest that behavioural optometrists, who routinely provide comprehensive assessment of accommodation and convergence, should consider this their “standard” and so not bill an Item 10943 for such testing, would be to financially penalise behavioural optometrists for providing a higher level of care.

Item 10943 is specifically excluded for “the assessment of learning difficulties or learning disabilities”. Optometrists assess visual function for all children, whether there is a learning difficulty present or not. Assessment of accommodation and vergence is necessary in all cases of paediatric assessment, to ensure any child is able to take in clear visual information comfortably and with minimal effort. Any such assessment which requires further testing should be billed as described above, whether or not the child has a learning concern ie even though a child’s presenting concerns include learning-related issues, if it is necessary to delineate and/or treat an accommodative or vergence dysfunction, then an Item 10943 applies.

If another optometrist has already billed the patient an Item 10943 in the last 12 months, when it is necessary for you to carry out testing normally covered in an Item 10943 it should still be billed with the patient advised that the further testing is necessary to properly diagnose and treat the dysfunction, but there will be no rebate due to Medicare’s rules that only one rebate is paid every 12 months. For instance, it is possible another optometrist could charge a patient an Item 10900 and 10943, but not provide effective treatment, or the parents seek a second opinion. You are entitled to bill an initial consultation (full) (with the patient only received half the normal rebate), and 10943 (non - rebatable) if you have to carry out additional testing beyond your basic, standard routine to diagnose and/or treat the dysfunction). It is also possible another optometrist might bill a patient 10900/10918 plus 10943, then refer to you for further diagnosis and/or treatment. You should then bill an Item 10905 (referred initial) plus Item 10943 (non – rebatable).

In accordance with the Medicare Benefits Schedule clause O6.38, Item 10943 is only payable “where a finding of significant binocular or accommodative dysfunction is the outcome of the consultation and assessment/testing”. In other words, if your standard testing suggests the presence of an accommodative or binocular vision dysfunction, but additional testing does not establish a diagnosis of a “significant” dysfunction, Item 10943 should not be billed.

When Item 10943 is billed, practitioners should ensure the diagnosis (diagnoses) resulting from the additional testing is (are) specifically recorded in the patient’s records. That is, there should be a clear connection evident in the written records between the patient symptoms, optometric clinical results including additional test probes, recorded diagnoses and treatment/management plan.

 

* These notes for guidance were written in 2005 by Stephen Leslie B Optom FACBO FCOVD, and are provided by ACBO for the use of members in optometric practice. The notes are advice based on optometric experience of, and interpretation of the Medicare schedule changes by the author. ACBO members should carefully consider the Medicare schedule and these notes for guidance before implementing their own practice protocols.
Any questions should be directed to This email address is being protected from spambots. You need JavaScript enabled to view it..

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