92004 vs 92002

pegjoh5746

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Elizabeth, CO
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I have a patient that came in as a new patient the provider performed a comprehensive exam and prescribes them glasses. What level of service would you recommend?
 

katf8454

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920x4's have to have confrontation visual fields and an extraocular muscle check. They should also be establishing a care relationship. If it was a basic healthy exam with no follow up reasons, I would recommend 920x2 but an argument could be made for 920x4 if both VF and muscles were checked.
 

Cheezum51

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92004 without question as long as the criteria for using the code are met, which I'll assume they were since the exam is described as "comprehensive." Why would you use a 92002, which pays about $80, when you've done the work for a 92004 which pays about $150? Also, if a refraction was done, remember to bill the 92015 and charge the patient for that service, which they would most likely pay out of pocket because very few medical plans pay for that code.

Tom Cheezum, O.D., CPC, COPC
 
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Cheezum51

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I'm hearing that several insurers are denying the 92 codes with medical diagnoses because they consider the codes to be for "routine" non medical care. Where in the world they came up with this is beyond me and most other coders don't understand it either. So, I'd just file the claims using the 99 codes instead, which seem to be accepted for medical eye care.
It sounds like the major medical insurers are starting to, as I term it, bastardize the CPT codes for their own purposes just as the "wellness" discounted vision care plans have done.

Tom Cheezum, OD, CPC, COPC
 
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