Ophthalmology and Optometry Coding Alert

Question: What is a refraction? Isn't it part of every eye exam? Florida Subscriber Answer: Best corrected visual acuity (BCVA) is always determined in a comprehensive examination (92004, 92014). This part of the exam can distinguish between a problem that is refractive and one that is non-refractive sometimes termed a "diagnostic refraction." Refraction that requires the physician to determine what kind of lens prescription is required takes more work and calls for a separate code (92015) whether or not a new prescription is written.

The BCVA is part of any E/M or eye code exam: A refraction is more than that. With BCVA the patient looks at a chart while wearing his or her current correction (glasses or contact lenses), and a pinhole implement is used to see if the patient's vision improves. If you bill that as a refraction with 92015, you are not following CPT. The refraction requires that either a trial lens set or a Phoropter be used. The patient is checked with different powers of corrective lenses to determine what lens power and axis of astigmatism provide the best vision closest to 20/20 as possible in each eye. This may be done for a new eyeglass or contact prescription or as a diagnostic service to determine the presence or severity of a medical condition.