Ophthalmology and Optometry Coding Alert

Use these handy definitions to determine if an E/M or eye code is more appropriate

When you're preparing to code an office visit, documentation is the key to being able to justify the level of code you report. Use this chart to help determine which code -- and which level -- fits the scenario. E/M Codes New patient

Has not seen the ophthalmologist, or another ophthalmologist in the same group practice, within the past three years.

• 99201 -- Problem-focused history, problem-focused exam, and straightforward medical decision-making

• 99202 -- Expanded problem-focused history, expanded problem-focused exam, and straightforward medical decision-making 

• 99203 -- Detailed history, detailed exam, and low-complexity medical decision-making 

• 99204 -- Comprehensive history, comprehensive exam, and moderate-complexity medical decision-making 

• 99205 -- Comprehensive history, comprehensive exam, and high-complexity medical decision-making.  Established patient

Has seen the ophthalmologist, or another ophthalmologist in the same group, within the past three years.

• 99211 -- May not require the presence of a physician

• 99212 -- Two of three: problem-focused history, problem-focused exam, or straightforward medical  decision-making  • 99213 -- Two of three: expanded history, expanded exam, or low-complexity medical decision-making

• 99214 -- Two of three: detailed history, detailed  exam, or moderate-complexity medical decision- making

• 99215 -- Two of three: comprehensive history, comprehensive exam, or high-complexity medical  decision-making. 

Note: To differentiate between different levels of service, see "Instructions for Selecting a Level of E/M Service" in the E/M codes' introduction in the CPT book. General Ophthalmological Services Codes New patient

Has not seen the ophthalmologist, or another ophthalmologist in the same group practice, within the past three years.

• 92002 -- Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient

• 92004 -- ... comprehensive, new patient, one or more visits.  Established patient

Has seen the ophthalmologist, or another ophthalmologist in the same group, within the past three years.

• 92012 -- Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient

• 92014 -- ... comprehensive, established patient, one or more visits.