Wiki 2ND POST!! Comprehensive exams and Treatment Question. Please help!!

[kmfeldman13]

Hello all! If we bill 92004 or 92014, must we have prescription of medication? Also, does it have to be prescription medication or can we prescribe OTC meds and such and consider that as prescription of medication? For an intermediate (92002/92012), is any prescription of medication or treatment required? According to the AMA book, the definition of an intermediate exam is an evaluation of new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis. It does not mention anything about requiring or prescribing treatment. We had a previous lecture where we were advised that treatment is required for intermediate exams. Needing some immediate clarification please! Thank you!

 

[tmorgan808]

The 2022 CPT book defines the intermediate and comprehensive examinations and what is required for each of them. The comprehensive says 'it always includes initiation of a diagnostic and treatment program'. The diagnostic and treatment program includes the prescription of medication, and arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services. When coding E/M services prescription medications and OTC medications are not the same, there I would use the same rules for these services. Hope this helps.

 

[natashalage]

Hi , I am new to eye codes but so far, I didn't hear that we must have medication management for 92004, 92014. As long, I have enough elements for Intermediate exam and MD discusses pt's eye condition, I can bill for such services.

 

[Cheezum51]

Those codes do require initiation or continuation of a treatment program and would include even having the patient utilize OTC products, such as those used for dry eye. However, OTC products are excluded from Prescription Drug Management for the 992xx E/M codes.