Question Ophthalmic codes

Stenglein

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Is a provider allowed to calculate a 92 ophthalmic code, using a refraction for diagnostic purposes and no rx is given? RTC is PRN. Seeing this with providers lately and it is the only piece I have to consider the 92 code! I have my own thoughts but want to hear any arguments for or against. I know the provider will be asking for answers. Thanks for your input!!
 

Cheezum51

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I don't quite understand your question but will try to answer as best I can. A 920x2 needs to have 3-7 exam elements and a 920x4 needs 8 or more exam elements. A refraction is not considered an exam element. If a provider is only doing a refraction and billing that for either code, it doesn't qualify for that billing. They should just bill a 92015 refraction code.

Tom Cheezum, OD, CPC, COPC
 

Stenglein

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I see "refraction done today for diagnostic purposes." To me, this does not count for the use of 92 ophthalmic codes. I feel they are trying to do this and wanted to hear an opinion.
 
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