COA exam prep for your ophthalmic assistants

A patient reports double vision. Which single follow-up question most narrows what the provider needs to consider?

Whether diplopia resolves when either eye is covered separates binocular from monocular double vision, and those two findings send the workup down different paths. It is also a question the assistant can ask and record without interpreting the result. Frequency, a recent spectacle check, and the effect of bright light are all worth documenting, but none of them draws that dividing line.

A patient on a glaucoma drop admits she cannot get it into her eye and has been missing most doses. What is the best action?

A patient who cannot instill a pressure-lowering drop is an untreated patient, which is a treatment failure the provider needs to hear about at this visit; the correct response is teaching plus escalation, not teaching alone. Repeating the demonstration and sending her home leaves the same physical barrier in place. Referring her to the pharmacist offloads a clinical problem onto a retail setting. Deferring it to the next visit leaves the intraocular pressure untreated in the meantime.

The lower semicircle is noticeably larger than the upper one and the endpoint will not settle. What is the correction?

Unequal semicircles mean the prism is off the corneal apex vertically, and the correction is made toward the larger semicircle: a larger lower mire means the prism is sitting above the apex, so the tonometer comes down slightly until the two match. Fluorescein volume changes the thickness of both mires equally, not their relative size. Turning the drum changes the applanated area, not the centration, so it cannot equalize them. Starting over with the drum at 0 lets the arm indent the cornea on first contact, which is why the drum is set to 1 beforehand.

While you are scribing, a coworker suggests recording that a full review of systems was performed, because that is what supports the level the provider usually bills. What do you do?

Recording an element that was not performed so that a visit bills at a higher level is upcoding, and a claim submitted on the back of it is a false claim under the False Claims Act - the person who typed it is part of it, whoever asked for it. The right move is to document what was actually done and route the request to the provider or the practice's compliance contact. Deferring to a coworker's reading of the billing rules does not transfer the responsibility, annotating the chart with who asked still leaves a false entry standing in the record, and staying quiet leaves the same request waiting for the next person to be asked.

Midway through a 24-2 you notice the gaze tracking trace has filled with a dense run of tall upward deflections, though the printed fixation loss counter still reads low. What is the most appropriate response?

Tall upward deflections on the gaze trace mean the eye is repeatedly leaving fixation, and a pause to recoach and reseat the patient can rescue the test while the patient is still in the chair. Documenting after the fact leaves the provider with a compromised field that has to be repeated at another visit. Switching strategy mid-series breaks comparability with prior fields and is the provider's decision. Changing stimulus size alters the test parameters and does nothing about fixation.