INTERACTIVE VOICE RESPONSE SYSTEM

The IVR (Interactive Voice Response) system will be modified to include an option to allow providers to enter an oculo-visual assessment fee schedule code, and will be available April 1, 1998. The system will return information about the most recent oculo-visual assessment date of service, according to claims which have been received and approved for payment by OHIP. This will assist the provider in determining if an oculo-visual assessment may be an insured service.

Further details will be provided in a separate Bulletin, "Modifications to Interactive Voice Response System, Effective April 1, 1998", which will follow shortly.

It is important to you, as an optometrist providing these services, to have registered for IVR and obtained your PIN (Personal Identification Number) by April 1, 1998.

For more information on IVR and how to obtain a Personal Information Number please contact the IVR Help Desk at 1-800-262-6524; in Kingston, 548-7981.

DESCRIPTION

Effective April 1, 1998, the following services rendered by an optometrist are prescribed as insured services. It is a condition for payment that the claim include the diagnostic code that relates to the patient’s condition.

1. A periodic oculo-visual assessment is an assessment of the eye conducted to determine refractive errors due to myopia, hypermetropia, presbyopia, anisometropia and astigmatism and, if necessary, to provide a written refractive prescription.
   
   A periodic oculo-visual assessment shall include the performance of refraction and may include the following elements:

1. The history of the complaint.
2. The patient’s medical history.
3. A visual acuity examination.
4. An ocular mobility examination.
5. Slit lamp examination of the anterior segment.
6. Ophthalmoscopy.
7. Tonometry.
8. Advice or instructions to patient.

A periodic oculo-visual assessment rendered by an optometrist is not an insured service unless,

1. in the case of an assessment of a patient who is 19 years of age or younger or who is 65 years of age or older, it has been at least one year since a previous periodic oculo-visual assessment was rendered by an optometrist or physician.
2. in the case of an assessment of a patient who is older than 19 and younger than 65, it has been at least two years since a previous periodic oculo-visual assessment was rendered by an optometrist or physician.

One additional periodic oculo-visual assessment of a patient described in clause (b) above is an insured service if,

1. it is performed during the second year that follows the previous periodic oculo-visual assessment referred to in clause (b) above; and
2. it is required to correct a refractive error equal to or greater than a 0.5 diopters spherical equivalent that is directly attributable to a trauma or disease suffered by the patient. Myopia, hypermetropia, presbyopia, anisometropia or astigmatism shall not constitute a disease for these purposes.

2. An oculo-visual minor assessment is conducted in order to provide a re-assessment following a periodic oculo-visual assessment or in order to assess an oculo-visual disorder other than a refractive error due to conditions listed in 1 above.
   
   An oculo-visual minor assessment may include any diagnostic and therapeutic procedures.

FEE SERVICE CODES

Questions may be directed to your Ministry of Health processing office.