Wiki Audit for optometry

[az2tn@yahoo.com]

I've been asked to conduct an audit for optometry at my facility. The problem is that I have never coded for it. I've just started researching and since optometry has its own codes(92002,92004,92012, 92014) but can use E/M's as well I'm confused in what situation would you use each of them?
Also could anyone recommend any training materials?

I found these books on Amazon. Does anyone know if either of these would be a good reference?

1.Coders' Specialty Guide 2018: Ophthalmology/Optometry 1st Edition

2.Medical ICD-10 Coding and Documentation Guidelines: For Optometry

Thanks for your help!!

 

[Cheezum51]

As far as resources, book #1 is probably the best choice.

In regards to the use of the 92xxx codes, they should be used only when initiating or continuing a treatment plan, such as prescribing medication for glaucoma or an eye infection. Referrals to other specialists is also continued as a treatment plan for purposes of their use. If the O.D. doesn't start any treatment then the 99xxx codes would be used the majority of the time.

All of that being said, some insurance carriers "break" the CPT code rules by requiring O.D.s to file claims only using the 92xxx codes and ignore the fact that no treatment is initiated or continued. Also, Vision Care Plans, such as VSP, Eyemed, only use the 92xxx codes for claims submitted for their services.

There are also certain exam elements which have to be done for the 92002 code which are exam of ocular adnexa, gross visual fields and ocular motility. For the 92012 code, the only requirement is exam of the ocular adnexa. In addition to the required elements for each of these codes, the examination for the specific problem outlined in the chief complaint and HPI also has to be addressed.

Good luck with your audit.

Tom Cheezum, O.D., CPC, COPC

 

[Cheezum51]

P.S. If you find the amount of research you have to do for this project is too time consuming and your facility decides to use an outside resource, I do consulting work and lecturing for record keeping, billing and coding for optometry and also do audits for offices when requested.

I was in practice for 40 years and help the AAPC develop its Certified Ophthalmology Professional Coder (COPC) program.

Tom Cheezum, O.D., CPC, COPC
tcheezum@cox.net

 

[az2tn@yahoo.com]

P.S. If you find the amount of research you have to do for this project is too time consuming and your facility decides to use an outside resource, I do consulting work and lecturing for record keeping, billing and coding for optometry and also do audits for offices when requested.

I was in practice for 40 years and help the AAPC develop its Certified Ophthalmology Professional Coder (COPC) program.

Tom Cheezum, O.D., CPC, COPC
tcheezum@cox.net

Thank you so much for your help. I will talk with my boss and see if that is something that would be in our budget. I will reach out to you through email. Thanks again!!