Ophthalmology and Optometry Coding Alert

Question: Are there limits on how often I should use office visit codes for my patients?

Illinois Subscriber  
Answer: Some carriers have frequency requirements for comprehensive eye codes and for E/M codes. Most limit 92014 (ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) to once every six months without additional explanation of the medical necessity for more frequently performed comprehensive exams. For E/M codes, frequency limits tend to be restricted to levels four and five. A denial based on too frequent performance doesnt mean nonpayment, but it does mean the claim will go through the appeals process. If you bill for a comprehensive eye exam more frequently than the carrier allows, bear in mind that documentation will probably be requested.  
Answers contributed by Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; Flo Curtis, office manager, Eye and Facial Surgery of New Mexico, Albuquerque; and Michael X. Repka, MD, member, AMA CPT advisory committee, Johns Hopkins Hospital, Baltimore.