Ophthalmology and Optometry Coding Alert

If your distribution looks much different, you could be raising a red flag

A thorough internal audit should include a look at your code use. Medicare keeps track of how often ophthalmologists report certain E/M codes -- and if you vary from the pattern too much, they may want to know why.
 
Here's how ophthalmologists used the office visit E/M codes in calendar year 2004 (see chart at top right). In all, Medicare paid ophthalmologists for 6,413,929 office visits in 2004. Look at the allowed services for each as a percentage of the total and compare with your own data with chart (bottom right). Although the rates might vary in different locations, this data would lead Medicare to expect about 2 percent of your E/M visits to be 99203 and 45 percent CPT 99213 , for example.
 
Do this: Check with your specialty society or association for more complete data. Download national billing statistics from Medicare at www.cms.hhs.gov/MedicareFeeforSvcPartsAB (click on "Medicare Utilization for Part B," then on "E/M Codes By Specialty").