Ophthalmology and Optometry Coding Alert

Determine the difference between intermediate and comprehensive You must know the four distinct characteristics of the eye exam codes to report these services correctly.

CPT divides general ophthalmological services into new and established patient categories, as well as intermediate and comprehensive:

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

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. To report the evaluation of new or exiting conditions that have been complicated by a new diagnostic or management problem, use 92002 for a new patient or 92012 for an established patient.

To report the evaluation of the complete visual system and treatment over the course of one or more visits, use 92004 for a new patient or 92014 for an established patient.

Both the E/M codes (99201-99215, Office or other outpatient visit ) and the general ophthalmological services codes (92002-92014, Ophthalmological services: medical examination and evaluation ), describe office visits. So how should you decide which to report Switch to E/M Codes for Complicated Exams Don't choose based on amount of reimbursement. The general rule for CPT codes is to pick the code that most clearly describes the service your physician renders. If you are strictly evaluating the function of the eye, report an eye code. If, however, you are evaluating the eye as related to a systemic disease process, report the appropriate E/M code.

Example 1: A new patient presents complaining of blurred vision. You perform a comprehensive examination, including checking her visual acuity, gross visual fields, ocular mobility, retinas and intraocular pressure. Because this is strictly an examination of the eyes function, use 92004.

In this case, the proper treatment may be to continue monitoring the condition without treating at this point.

Example 2: A patient with chronic blepharitis comes in due to a recent foreign-body sensation. During the case history, the patient mentions a recurring headache. The patient had an unremarkable comprehensive exam four months ago, and you don't think it's necessary to do another dilated exam. A slit-lamp exam reveals a lash rubbing the cornea on the painful eye. Refraction indicates a significant increase in hyperopia, which may explain the headache.

You can report an E/M code as long as you meet the higher standard of documentation for the E/M codes. Be sure to document the date of onset, frequency and duration of symptoms, level of discomfort, whether the condition is improving, and other details defined in the E/M codes that the eye codes don't specify. Patients With Medicare and Routine Vision Plans Along with Medicare or other [...]