Optometry Coding & Billing Alert

Published on Mon Jan 10, 2011 PDF

Question: Can we submit 99213 for an office visit and 92065 for vision training on the same date of service?

Answer: Vision training code 92065 (Orthoptic and/or pleoptic training, with continuing medical direction and evaluation) is not bundled with E/M code 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). You can report these two codes together on the same date of service.

Keep in mind: There must be medical necessity for providing the E/M service and documentation should be separately identifiable in the medical record to support the need and level of service. Some carriers or private payers may require the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service. The office visit must be able to stand alone as a procedure without the vision training session, so ask yourself, "Would 99213 have been needed even if the 92065 procedure had not been done?"

However: Note that 92065 is bundled with 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...).

Also include the recommendations or prescription from the referring physician for the vision training (92065) in addition to documentation in the medical record to support the medical necessity for the office visit (99213). The vision training can be done under general supervision by a technician -- but, of course, the physician must perform the OV.

Documentation of the training by a technician must also support direction and oversight by the physician.

The claim should also show the referring physician's name (which may be the actual physician submitting the charge).