Revenue Cycle Insider

Question: I work for an ophthalmologist who also has a retina subspecialty. The provider wants to report 92202 with eye examination codes, seeing as they do not use evaluation and management (E/M) codes for visits.

Is this possible?

Illinois Subscriber

Answer: Yes, you can report 92202 (Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral) along with eye examination codes, such as the following:

• 92012 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient)
• 92014 (… comprehensive, established patient, 1 or more visits)

The National Correct Coding Initiative (NCCI) edits do not indicate the code pairs cannot be reported together, and by not reporting the eye examination, your ophthalmologist could be missing out on potential revenue for the practice.

Of course, double-check with your individual payer to confirm how it wants you to report the procedures to ensure your claim is compliant with its procedures.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC