E/M Vs. Eye Codes
I use 92004, 92014, 92002, 92012 for Eye Examinations and base my code selection on Medicare and Medicaid guidelines for each.
_______________________________________________________
The Medicaid provider manual on emedny.org spells out pretty clearly when to use each code and what medicaid considers to be a complete optometric exam. There needs to be a case history, internal and external eye exam, objective and subjective determination of refractive state, binocular coordination testing, gross visual field and tonometry for recipients age 35 and over and routine opthalmoscopy and controntational testing for visual assessment. If these requirements are not met, I use an E/M code.
___________________________________________________________
By Medicare standards, there are 11 elements of an opthalmologic exam: test visual acuity, gross visual fields, eyelids and adnexa, ocular mobility, pupils/iris, cornea, anterior chamber, lens, intraocular pressure, retina, and optic disc. Intermediate and comprehensive exam codes require evaluation of eight or more elements.
For 92002-92012 you need eight elements plus a history, general medical observation, and external ocular and adnexal exam.
For 92004-92014 you need eight elements plus history, general medical observation, external and opthalmoscopic exam, gross visual field and basic sensorimotor exam. It often includes biomocroscopy, examination with cycloplegia or mydriasis and tonometry. It always includes initiation of a diagnostic treatment program.