Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: The state of Florida Workers Compensation reimburses $29.00 under CPT code 99025 for an exam of a new patient who presents for a removal of a foreign body. (The removal of the foreign body, CPT code 65222, reimburses $40.00) Because the reimbursement is similar to a limited exam and a full exam is very time consuming for this level of reimbursement, how much of an exam am I legally responsible for under CPT code 99025? For example, would it be ok to just document a vision and a slit lamp exam of the eye with the foreign body only, or do I have to do a full eight? Part exam including dilated fundus exam of both eyes?

Anonymous Florida Subscriber


Answer: Code 99025 is specifically designed for those times when a new patient comes to your office for a starred procedure, and all you do is the procedure. It is designed to aid in reimbursement for practice costs for a new patient when no significant level of evaluation and management is provided. The documentation should be the performance of the procedure, and any pertinent history, which may be as brief as this: Patient presents from work with suspected foreign body in right eye. Was not wearing protective eyewear, says, Something flew into my eye from the machine. No draining, no obvious lacerations, some redness and tearing.