Ophthalmology and Optometry Coding Alert

Ophthalmology coders have the luxury of having two sets of codes to represent office visits E/M codes and eye codes that is, if you know when these codes can and can't be used interchangeably.

"While ophthalmologists have the option of utilizing the ophthalmic exam codes (92002-92499) or codes from the Evaluation and Management series (99xxx) for patient exams, our goal is to always choose the code that best describes the service performed," says Linda Abel, CPC, assistant administrator with Hauser-Ross Eye Institute in Sycamore, Ill.

For unique eye codes 92002-92014 to feel like a blessing, you first need to understand what these codes encompass and when they should be reported.

"The basic difference between the two sets of codes is that the eye codes are used for evaluating the function of the eye, whereas the E/M codes are generally used when the physician is evaluating a more systemic disease process," says Susan Callaway, CPC, CCS-P, an independent coding consultant in North Augusta, S.C. She cites the example of a patient with some symptoms of glaucoma but also with headaches that need to be evaluated in the context of the patient's current condition. This additional evaluation, with the appropriate documentation, constitutes an E/M service.

"But if a patient comes in with just the complaint 'I can't see well,' then the ophthalmologist will simply be evaluating the function of the eye, justifying the use of an eye code," Callaway says. Sometimes it is hard to tell whether an eye code or an E/M code is appropriate.

For example, suppose a patient comes in for her regular checkup and says, "By the way, I have these other problems or concerns." "This could really go either way and require eye or E/M codes," Callaway says. "Then it is your responsibility to follow the basic CPT rules that advise you to pick the code that most clearly describes the services you are rendering." The eye codes, like the E/M codes, are divided into new patient (92002 and 92004) and established patient (92012 and 92014) classifications, which are further broken down by their level of service. Unlike the E/M codes, the eye codes have only two levels of service, intermediate and comprehensive, making it easier to determine the level of service that your ophthalmologist has provided to a patient. Use this chart comparing the components of intermediate and comprehensive eye codes to help delineate between the two.
Differentiation by Documentation The question still looms: Why would an ophthalmologist or coder opt to use the eye codes instead of the E/M codes, when either set is applicable? [...]