Guide to supplementary reason codes

This guidance, clarifying the use of the following supplementary reason codes, was produced in consultation with the Scottish Government Health Directorates and Optometry Scotland.

If you carry out a supplementary eye examination on the same day as a primary eye examination, full details of the reasons why must be provided in the patient’s records. You must enter the relevant reason code on your claim.

For the purposes of NHS primary and supplementary eye examinations, a 'sight test' means a refraction.

Standard Supplementary Eye Examination

3.0 – Additional or Significantly Longer Appointment To Complete Primary Eye Examination For A Patient With Complex Needs

This code can be used for an additional appointment (whether or not on the same day as the first appointment), or a significantly longer single appointment, required to complete a primary eye examination in practice premises for a patient with complex needs, when more time to complete the examination is needed. This code should be claimed in addition to the relevant primary eye examination fee. This code must not be used more than once per day for the same patient. A patient with complex needs is a patient who has a physical or mental condition and, as a result of that condition, the patient’s primary eye examination must be conducted significantly more slowly than that of a typical patient who does not have a physical or mental condition. This includes circumstances where a sign-language interpreter is required because of the patient’s physical or mental condition. A patient must not be treated as having complex needs solely due to their age.

3.1 – Paediatric Review (without dilation/cycloplegia that does not follow a primary eye examination)

This code is to be used to review a child within 12 months of a primary eye examination, as judged clinically necessary, and dilation/cycloplegia is not required.

3.2 – Follow-Up / Repeat Procedures (without dilation and not associated with glaucoma)

This code is to be used for additional or repeat procedures not requiring dilation and which are required to refine a diagnosis or clinical outcome in order to determine whether the patient needs referral or can be retained for ongoing care in the community. This code can be used for a refraction, on a separate day, that could not be undertaken at the primary eye examination.

3.3 – Suspect Glaucoma (without dilation)

This code is to be used specifically for suspect glaucoma review, in keeping with SIGN 144 guidance for diagnosis and referral for glaucoma, and which does not require dilation. This includes ocular hypertension.

3.5 – Anterior Eye Condition (without dilation)

This code is to be used for a supplementary eye examination of a patient (in person or using remote facilities) with a suspect or diagnosed anterior eye condition within the normal interval between primary eye examinations, and which does not require dilation. Practitioners should follow Annex C to determine how to make an appropriate claim for treatment of an anterior eye condition.

3.7 – Post-Operative Cataract Examination (without dilation)

This code is to be used for a post-operative cataract examination of a patient, which includes refraction, an ocular examination and (if required) a feedback report, but does not require dilation. This code should not be used for a post-operative cataract examination of a patient where a GOS provider has, is or will receive remuneration outwith GOS arrangements for undertaking the appointment. Such examinations do not form part of GOS.

3.8 – Unscheduled Appointment (without dilation)

This code is to be used for a supplementary eye examination for a patient (in person or using remote facilities) who presents with symptoms for an unscheduled appointment within the normal interval between primary eye examinations, and which does not require dilation.

3.9 – Cataract Referral Advice and Counselling

This code is to be used when providing advice and counselling to a patient (in person or using remote facilities) following an eye examination which has resulted in the patient being considered for referral. This may include providing prognosis or counselling and preparation for consent for cataract surgery, including risk factors.

Enhanced Supplementary Eye Examination Codes

Conduct an enhanced supplementary eye examination when you deem it clinically appropriate to support the care of the patient.

4.1 – Paediatric Review (with dilation or cycloplegic refraction)

This code is to be used to review a child within 12 months of a primary eye examination, as judged clinically necessary, and dilation/cycloplegia is required. This code is also to be used to facilitate the cycloplegic refraction of a child aged under 16 when the cycloplegic refraction is undertaken on a different day to a primary eye examination. If the cycloplegic refraction is undertaken on the same day as a primary eye examination then only the relevant primary eye examination fee can be claimed.

4.2 – Follow-up / Repeat Procedures (with dilation and not associated with glaucoma)

This code is to be used for additional or repeat procedures requiring dilation and which are required to refine a diagnosis or clinical outcome in order to determine whether the patient needs referral or can be retained for ongoing care in the community.

4.3 – Suspect Glaucoma (with dilation)

This code is to be used specifically for a suspect glaucoma review, in keeping with SIGN 144 guidance for diagnosis and referral for glaucoma, and which requires dilation. This includes ocular hypertension.

4.5 – Anterior Eye Condition (with dilation)

This code is to be used for a supplementary eye examination of a patient with a suspect or diagnosed anterior eye condition within the normal interval between primary eye examinations, and which requires dilation. Practitioners should follow Annex C to determine how to make an appropriate claim for treatment of an anterior eye condition.

4.6 – Cycloplegic Refraction of a Child Referred From the Hospital Eye Service

To facilitate the cycloplegic refraction of a child aged under 16 referred from the hospital eye service. The supplementary eye examination must include an internal and external examination of the eye.

4.7 – Post-Operative Cataract Examination (with dilation)

This code is to be used for a post-operative cataract examination of a patient, which includes refraction, an ocular examination and (if required) a feedback report, and also requires dilation. This code should not be used for a post-operative cataract examination of a patient where a GOS provider has, is or will receive remuneration outwith GOS arrangements for undertaking the appointment. Such examinations do not form part of GOS.

4.8 – Unscheduled Appointment (with dilation)

This code is to be used for a supplementary eye examination for a patient who presents with symptoms for an unscheduled appointment within the normal interval between primary eye examinations, and which requires dilation.

Specialist Supplementary Reason Codes

A specialist supplementary eye examination must only be carried out at a location that forms part of arrangements that a Health Board has entered into regarding the provision of specialist supplementary eye examinations. A specialist supplementary eye examination should be conducted where it is deemed clinically appropriate to support the care of the patient. A specialist IP optometrist or specialist OMP must not provide Stage 2 treatment to a patient earlier than clinically necessary solely to claim a specialist supplementary eye examination fee.

5.0 – First Specialist Supplementary Eye Examination Appointment

This code is to be used for the first specialist supplementary eye examination of a patient:

• who has presented, without referral, to a specialist IP optometrist or specialist OMP, and receives any Stage 2 treatment as specified in Annex C; or

• who has been referred under paragraph 14(4) of schedule 1 of the 2006 Regulations to a specialist IP optometrist or specialist OMP, and receives any Stage 2 treatment as specified in Annex C.

No GOS claim can be made for clinically triaging a patient before accepting a referral.

Patients who are referred but do not need Stage 2 treatment.

Where the patient is referred, if, after the specialist IP optometrist or specialist OMP has reviewed the patient’s presenting signs, symptoms and needs, they determine that the patient does not have an anterior eye condition requiring Stage 2 treatment, a supplementary eye examination under a 5.0 reason code can still be claimed.

Patients managed by different clinicians within a practice where:

• a patient has an appointment with an optometrist or OMP in relation to a suspect or diagnosed anterior eye condition that is anticipated to require Stage 2 treatment; and

• as a result of that appointment the patient is then directed to receive any Stage 2 treatment from a specialist IP optometrist or specialist OMP during a separate appointment on the same day within the same optometry practice location,

only one supplementary eye examination claim must be made in relation to both appointments, under reason code 5.0. The patient notes should clearly record each practitioner’s professional contribution to the management of the patient.

Episodes of care.

An episode of care at Stage 2 is defined as being complete when the condition:

• has been resolved successfully;

• does not respond to treatment or does not resolve, and onward referral is made to an ophthalmic hospital or to the patient’s GP practice for medical support/intervention; or

• steps down to Stage 1 treatment.

Where an episode of care is complete and no follow-up appointments with the patient are scheduled, and the anterior eye condition later reoccurs such that the specialist IP optometrist or specialist OMP determines that the provision of any Stage 2 treatment is clinically required in accordance with Annex C, then a new episode of care is deemed to have commenced and a specialist supplementary eye examination claim under reason code 5.0 can be made.

5.1 – Second Or Subsequent Specialist Supplementary Eye Examination Appointment (or where onward referral to an ophthalmic hospital or a General Practitioner is required)

This code is to be used in the following circumstances:

• for the second and subsequent specialist supplementary eye examination of a patient who receives any Stage 2 treatment as specified in Annex C. This would normally be with the same specialist IP optometrist or specialist OMP who initiated the Stage 2 treatment, but might be with another specialist IP optometrist or specialist OMP where the original IP optometrist or specialist OMP is no longer able to manage the patient (for example due to unexpected absence);

• where the patient is examined by a specialist IP optometrist or specialist OMP who determines that the patient has an anterior eye condition that requires more complex treatment than Stage 2 as specified in Annex C, and is therefore referred onto an ophthalmic hospital or a General Practitioner under paragraph 14(4) of schedule 1 of the 2006 Regulations.

Scheduled primary eye examination appointment during which Stage 2 treatment is provided.

In the unlikely event where a patient has a scheduled primary eye examination and, during that examination, the patient is diagnosed with an anterior eye condition and is provided with any Stage 2 treatment by a specialist IP optometrist or specialist OMP, then both a primary eye examination claim and a specialist supplementary eye examination claim under reason code 5.1 can be made.

Further information and support

The codes were updated following changes introduced to the fee structure for supplementary eye examinations introduced in the Primary Care Amendment letter PCA(O)2026(01)

Please do not hesitate to contact the team if you have any questions or queries on the above.

Email: nss.psdophthalmic@nhs.scot

Telephone: 0345 034 2458