Wiki New to Ophtho coding

[kathleenl]

Good Morning,

I am new to Ophthalmology coding/billing and am struggling to determine the difference between the comprehensive and intermediate codes (92002/92004 and 92012/92014) after reading the chapter header in the CPT book.

Can anyone help with some basic guidelines on what I should be looking for to distinguish between the two?

Any help/guidance is appreciated.

Thank you
-Kathleen

 

[AnissaM08]

Ophthalmology E&M Coding-

Hi Kathleen,

Welcome to Ophthalmology coding. Ophthalmic E&M codes are by far the easiest coding you'll ever do, once you get the hang of it.

New Patients:

92002- New/Intermediate- use this code when patient presents to the office for a routine eye exam w/ refractions, pre-op for cataract surgery (diagnostic exams included), eye exams w/ IOP checks, eye exams w/ minor surgery and/or injections (code seperately the injection & drug; appending a modifier 25 to the E&M), and straight forward eye exams with no additional tests done.

92004- New/Comprehensive- use this code when patient presents to the office for eye exams that require diagnostic tests (ie., Fundus, Visual Fields, OCTs, MRIs, Orbital CT Scans, etc.)

Established Patients:

92012- Use this code when established patients return to the office for routine visits, straight forward exams, pre-op for cataract surgery (diagnostic tests included), exams w/ IOP checks, eye exams w/ minor surgery and/or injections (code seperately the injection & drug; appending modifier 25 to E&M), and straight forward follow up exams with no additional tests done.

92014- Use this code when established patients return to the office requiring diagnostic tests (ie., Fundus, Visual Fields, OCTs, etc.) for medical diagnoses (ie., Diabetes, Glaucoma, BRVO, CME, etc)

I hope this helps.

A. Machelle Bowen, CPC, NCICS, OCS, AAHCA