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W.L. Marsh–Tootle, T.C. Wall, S. Strasser, E.E. Hartmann; Rates of well child visits, visual acuity screening, and diagnosis of amblyopia and strabismus among children aged 3 and 4 years with Alabama Medicaid. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1397.
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Purpose: To determine rates of well child visits, vision screening, and diagnosis of amblyopia or strabismus among a population of preschool children aged 3 to 4 years who are covered for these services by Alabama Medicaid. Methods: Claims data for children enrolled in Medicaid in the state of Alabama were reviewed for utilization of codes for well child visits, visual acuity screens (Z5316), and utilization of diagnostic codes for amblyopia (368) or strabismus (378). Data were reviewed for a one–year period from 10/01/01 until 9/30/02 and included results from children who were aged 3 or 4 years during that interval. Results: Among an estimated 54,294 eligible children, 54% (29,429/54,294) had a claim for a well child visit (EPSDT screen). Of these, 13% (3,970 / 29,429) had claims for visual acuity screening. Diagnosis codes for strabismus (378) were used in 1098 children (595 aged three and 503 aged four years). Codes for amblyopia (368) were used in 344 children (117 aged three and 227 aged four years), for an overall diagnosis rate of strabismus or amblyopia in 2.7% (1442 / 54,294). Discussion: Approximately one half of Medicaid covered preschool children missed the opportunity for visual acuity screening and other preventive services because they did not attend well child visits. Among children who did attend, the vast majority did not receive visual acuity screening despite the availability of a small reimbursement ($5 in Alabama). Further examination of factors limiting visual acuity screening in preschool children is warranted. Since few children are selected for diagnostic care based on visual acuity results, other factors (physical exam, parental concern, etc.) must initiate most diagnostic exams.
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