1. Eye codes (92002/92004 and 92012/92014) vs. E/M codes- use eye codes whenever possible-that's why we have them, and they reimburse at higher rate: you need at least full SLE (slit eye exam) for intermediate eye codes and at least a dilated fundus exam,gross visual fields, and basic sensorymotor exam (pupil reaction, binocularity, ocular motility) for comprehensive eye codes.
2. E/M codes for Eye- more is explained at Trailblazer site-look up Evaluation and Management and use 1997 guidelines FOR SINGLE ORGAN SYSTEM-EYE for how many bullets per each level of E/M code and what corresponds to bullets on your group practice encounter form. Rule of thumb is if you don't have enough exam criteria to use eye codes then use the 1997 eye bullet guidelines to determine the exam level. ALWAYS LOOK AT THE MDM FIRST TO DETERMINE THE LEVEL OF SERVICE IF YOU ARE USING E/M CODES AND NOT EYE CODES.
3. Eye Codes for Eye- also on Trailblazer website is an 'LCD' window. If you type in the CPT of any of the 4 eye codes for the Colorado area the procedure will come up, press enter and scroll down to see what diagnosis codes (ICD-9's) are displayed. (These are the ICD-9 codes that Medicare will allow for the eye code billing to go through.) Print this out-www.trailblazerhealth.com/Tools/LCDs.
Now Let's Code!!!
1. Look at encounter-Est vs. New
2. review exam- can you use eye codes? if so then look at diagnosis and review LCD's to make sure it's covered-(even if an ophthalmologist does a comprehensive exam/history, if the patient has only myopia Medicare won't cover it. Most carriers follow Medicare billing practices.)
3. If not covered by medicare or exam doesn't meet eye code criteria, then you must use E/M criteria-history/exam/MDM. E/M's ARE VERY SPECIFIC. PRINT OUT AN EVALUATION AND MANAGEMENT SHEET AT THE TRAILBLAZER WEBSITE, PUT THE 4 SHEETS IN PLASTIC, AND USE THEM RELIGIOUSLY!!! Remember, MDM that is tied to Chief Complaint/Reason for Visit should primarily determine your level of service. (If a patient comes in for a glaucoma follow-up and all they do is an IOP check/continue current meds then this is a low risk MDM. No matter what they do with the history or bullets of eye exam, this level of service should be no greater than a 3.
Many coders do things differently, this is my way- Remember it is a learning process and mistakes are a GREAT TEACHER!!!! good luck!