I have been told that billing for a complete exam (92004/92014) more than once per year would be “upcoding” and could potentially be cause for an audit if used. One of the providers I code for is a retina surgeon. I review his notes for each exam and he is very thorough and almost always hits the criteria for a complete exam on every visit for a patient due to the high risk nature of the diseases his patients normally have. Am I okay to be billing 92014 on say a second or third visit, or would that be cause for alarm for payers? They want me to instead bill 92012 for every visit the rest of the year after a 92004/92014 is billed for a patient which I think is actually “undercoding.” At the very least I should be able to bill for a 99213 or 99214 if the criteria is met for those. Please let me know what you think.