Wiki 92014 Confusion

[jjulio3693]

Hello, I am wondering what codes other offices use for a routine eye exam. Do you use the eye code 92014? It is my understanding that you have to have a test done in order to bill that code. Refraction is included as a test. If the Dr doesn't do a refraction or another test we would need to use an E/M code. I am hoping that someone can help clarify this. Also what do you bill for diabetic exams? I appreciate any feedback that would help. Thank you!

 

[Cheezum51]

Unfortunately, the vision discount plans and several major medical insurers have "bastardized" the CPT code definitions, IMHO, and are denying payment for claims filed with the 99 E/M codes when there are only refractive diagnoses and are insisting that offices use the 920x4 code for "routine" exams. These codes do not require that you do a test in order to bill them. They only state that you have to initiate or continue treatment or testing for the patient. The AAOphthalmology has said that prescribing glasses counts as a treatment. Any part of the exam elements required to bill the 920x4 would qualify as a test and you don't have to do ancillary testing, such as photos or OCT, to bill those codes. For diabetic exams, you are dealing with a medical problem and can bill either the 92 or 99 codes. However, I would suggest using the 99 codes.

Tom Cheezum, OD, CPC, COPC