TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > Clinical Information

43.2.3.7 Sensory Screening

Vision Screening

Newborns

During the initial test at birth, the provider should do the following:

•Check for red reflex.

•Note history for high-risk conditions, such as congenital infections (rubella, herpes, and others) or a family history of vision or eye problems.

Birth Through 2 Years of Age

The provider should do the following:

•Collect observations and a history from a caregiver.

•Check for red reflex.

•Determine whether pupils equally react to light.

•Screen for heterophoria with the corneal light reflex and cover test for clients older than 6 months of age.

•Note history for high-risk conditions, such as congenital infections (rubella, herpes, and others) or a family history of vision or eye problems.

At 3 Through 4 Years of Age

The provider should do the following:

•Administer Tumbling E or HOTV test or equivalent at both the 3- and 4-year visit.

•Screen through the 20/20 line.

•Determine whether the client reads more than half of the 20/40 line or four out of six HOTV symbols; refer if unable to read the majority of 20/40 line (one more than half of the symbols) or four out of six HOTV symbols.

•Screen for heterophoria with the corneal light reflex and cover test or Random Dot E.

•Refer clients with a two-line difference between the two eyes.

•Document and complete the test as described for birth to 2 years of age if a 3-year-old is unable to cooperate.

For Clients 5 Years of Age and Older

The provider should do the following:

•Evaluate with a letter chart or Tumbling E chart at ages 5 through 10, 12, 15, and 18 years of age.

•Refer if unable to read the majority of 20/30 line (one more than half of the symbols) or four out of six HOTV symbols.

•Administer a cover test or Random Dot E.

Note: Documentation of the results of a school vision screening program may be used in place of testing in the office if within 12 months of the check up.

Vision Screening Supplies

Vision screening supplies can be ordered from the following vendors:

Refer to: "Vision Care (Optometrists, Opticians)" for more information.

Inpatient Hearing Screening

Newborn Hearing Screening

Health Safety Code, Chapter 47, Vernon's Texas Codes Annotated mandates that a hearing screening must be offered at the birthing facility before hospital discharge. The hospital is responsible for the purchase of equipment, training of personnel, screening of the newborns, certification of the program in accordance with DSHS standards, and notification to the provider, parents, and DSHS of screening results. There is no additional Medicaid reimbursement for the hearing screening, as the procedure is part of the newborn diagnosis-related group (DRG). Hospitals should use the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code 09547 to report this newborn hearing screen on the UB-04 CMS-1450.

This facility-based screening also meets the physician's required component for hearing screening in the inpatient newborn THSteps check up. The physician must assure that the hearing screening is offered or completed before discharging the newborn unless the birthing facility is exempt under the law from performing hearing screenings, in which case, the physician must assure there is an appropriate referral for a hearing screening to a birthing facility participating in the Newborn Hearing Screening Program.

The physician should discuss the screening results with the parents, especially if the hearing screening results are abnormal, and should order an appropriate referral for further diagnostic testing. If the results are abnormal, parent/legal guardian consent must be obtained to send information to DSHS for tracking and follow-up purposes.

A physician with any concerns about this process should contact the hospital administrator or the DSHS Audiology Services Program at 1-800-252-8023.

Initial Test at Birth

The provider should do the following:

•Verify that the parents received the results of the hearing screen at the birthing facility.

•Check for obvious physical abnormalities.

•Supply a Hearing Checklist for Parents and instruct in its use. This checklist should be discussed at the first in-office THSteps medical check up.

•Provide a referral for further diagnostic audiological testing for an infant with abnormal screening results or who is at high risk for hearing impairment.

Outpatient Hearing Screening and Diagnostic Testing for Clients

As part of the THSteps medical check up, physicians are required to complete the hearing screening component. Separate procedure codes should not be billed when hearing screenings are part of medical check ups or daycare/school requirements. Medicaid does not reimburse separately.

For clients that are seen in the office setting, the THSteps program requires a puretone audiometric test at visits where objective screening is required. In other childcare settings (e.g., daycare, preschool, Head Start, and elementary, middle, and high school), the DSHS Vision and Hearing Screening Program requires that a puretone audiometer be used for hearing screening.

Birth Through 3 Years of Age

The provider should do the following:

•Observe and record history from a responsible adult familiar with the client, using the Hearing Checklist for Parents located on page C-18, English and Spanish.

•Refer high-risk clients for further audiological diagnostic testing.

At 4 Years of Age and Older

The provider should do the following:

•Assess clients with a puretone audiometric hearing screen (1000, 2000, 4000 Hz) at 4 through 10 years of age.

•Perform a subjective hearing evaluation, which includes client history and observation of the client for the ability to answer questions and follow directions, at all other medical check ups where an audiometric screen is not required.

•Refer the client if any one of the three frequencies are recorded as greater than 25 dB in either ear.

At 11 Years of Age and Older

•The client must be assessed with a puretone audiometric hearing screen (1000, 2000, and 4000 Hz) at 12, 15, and 18 years of age.

•The client should have a subjective hearing evaluation at 11, 13, 14, 16, 17, 19, and 20 years of age that includes clientclient history and observation for the ability to answer questions and follow directions.

•Adolescents who do not respond to a 25 dB tone at any frequency should be referred for a diagnostic hearing evaluation.

Note: Documentation of the results of a school screening audiometric testing program may be used in place of testing in the office if within 12 months of the check up.

The CPT audiometric screening procedure codes 5/I-92551 and 5/I-92552 may not be billed on the same day by the same provider with THSteps medical check up procedure codes shown in the following table:

It is recommended that pneumatic otoscopy be the primary method to visualize and assess the mobility of the tympanic membrane when distinguishing between otitis media with effusion and acute otitis media.

Tympanometry (impedance testing) may be considered for reimbursement as an objective diagnostic test of middle ear disease. Tympanometry (procedure code 5-92567) should never be used as the sole clinical means to establish the presence or absence of acute or chronic middle ear effusion or infection. Direct otoscopic examination by a suitably qualified provider, with or without pneumatic otoscopy, is the key element of the standard method used to establish a diagnosis of middle ear disease. Tympanometry must be limited to selected individual cases where its use demonstrably adds to the provider's ability to establish a diagnosis and provide appropriate treatment.

Tympanometry is limited to four services per year by the same provider and is based on medical necessity. Medical necessity must be documented in the client's medical record. Tympanometry does not meet the requirements for a sensory screening component of the THSteps medical check up. Acoustic reflex testing does not meet the requirement for hearing screening and is diagnosis restricted.

Hearing Referrals

For information on referrals to the PACT program, see "Referrals for Medicaid-Covered Services" and "Benefits" .

Separate procedure codes may be billed for clients who require diagnostic hearing testing. The diagnostic audiometric testing codes 5/I-92567, 5/I-92585, 5-92586, 5/I/T-92587, and 5/I/T-92588 may be billed, as appropriate.