intermediate ophthalmology services


Adel, IA
Best answers
The CPT manual states an intermediate exam requires "evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis." To which I say, Huh? :) Does anyone know what this means, or can you provide an example?

The optometrist I code for sees some patients for a yearly exam and refraction. In some cases, she simply provides a new lens prescription for their vision issues. Does this fulfill the intermediate exam criteria by evaluating an existing condition (e.g. astigmatism) with a new management problem (e.g. patient needs a stronger lens prescription)?
Just a question. Why is the OD you work for doing a comprehensive annual exam and only coding for an intermediate exam? Those should be level 4 exams (92004 or 92014), assuming the appropriate history and exam elements are being done.

In a partial answer to your question, updating an eye glass or contact lens prescription is considered addressing a new problem such as "blurred vision."

However, as you know, that's not a medical diagnosis which can be billed to medical insurance unless perhaps the change is due to something like progression of cataracts.