E/M vs Vision Exam

sasharea

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Iowa City, IA
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Does anyone have any information they can supply me on understanding how to distinguish if the claim needs to be submitted using an E/M code or Vision code? I understand it depends on the payer, but what drives it to figure out if it should be E/M visit? Does it only get billed to medical if there is a medical problem?
 

drakena74

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Local Chapter Officer
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Fullerton, CA
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Vision codes are mainly used with routine eye visits and widely use with Vision insurances and optometrists.

Ophthalmologists use both vision & e/m codes. Some medical insurances may not pay the vision code with a medical diagnosis because they have assigned in their system the 92002 - 92014 codes as routine vision only. So you may have to change those codes to e/m instead.
 

Tiger

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The most important consideration in choosing between 92xxx and 99xxx code is the chief complaint or the reason for the encounter. If pt. Says he/she is here for annual check up. It shd go to routine vision ins. With 92xxx but if pt. Is having some medical issues it shd go to med ins with 99xxx. Having said that most medical ins will pay for 92xxx when billed with medical diag. Though they will not pay for refraction.
 
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