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Wiki Ophthalmology Resources

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kholbrook7

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Hello - I am new to coding outpatient ophthalmology services.
Can anyone recommend a good resource to purchase for these
surgical procedures. Thanks
 
I use the Ophthalmology Coding Coach from the AAO, however I bill general optometry more medical optometry/ophthalmology than most optometrists. That being said, we don't do surgery. It's been pretty helpful in my transition from all the specialties within Internal Medicine I did billing for in my previous job.
 
I second the Coding Coach book! It gives you common CCI edits, modifier help with codes, and what codes commonly go with certain CPTs. Well worth the money. I don't know if they are making one with ICD-10 codes or not, so you may want to wait and buy that one!
 
Optometry coding

Hi,

Would anyone know where I can find the requirements of the Vision Exam codes 92002, 92012 and 92004, 92014 done by an optometrist.

Thank you very much.
 
I definitely recommend the coding coach, as stated above. Easy to understand and read. If you are interested you could check out the AAO website for getting your Ophthalmic Coding Specialist (OCS) certification - Great resources for learning the ins and outs of Ophthalmic Coding.
Good Luck!
 
No difference.

tovygoldstein, there are no differences in what's required to bill those codes whether billed by an optometrist or ophthalmologist. The requirements for each code are listed in the "medical" coding section of the CPT book.

I assume I understood your question properly with what I said above.
 
My question was regarding the actual requirements for billing the comprehensive eye exam 92014,92004 vs. the intermediate 92012,92002 not in the difference between optometry and ophthalmology.

Thank you.
 
I am also new to coding ophthalmology. I was wondering if you could answer a question for me or direct me to someone who can?
I have a provider that billed for a surgery in August that has a 90 day global period, and then he brings the patient back in September and performs CPT code 92134 with a different diagnosis code. Am I able to apply a modifier 58,78, or 79 to any of these types of tests when performed in a global period of a surgery? Or does it matter? I know that if another surgical procedure was done that I would be able to, but I'm unsure of what to do about a test.
Thanks for any and all help!
 
Loutie said:
I am also new to coding ophthalmology. I was wondering if you could answer a question for me or direct me to someone who can?
I have a provider that billed for a surgery in August that has a 90 day global period, and then he brings the patient back in September and performs CPT code 92134 with a different diagnosis code. Am I able to apply a modifier 58,78, or 79 to any of these types of tests when performed in a global period of a surgery? Or does it matter? I know that if another surgical procedure was done that I would be able to, but I'm unsure of what to do about a test.
Thanks for any and all help!
Click to expand...

A modifier would not be necessary on an OCT test performed in the global period. Also note, a modifier of 24 is only applicable to E&M codes and ophthalmology exams (92004, 92014, etc.)

The global period also would only apply to an exam. If the patient, for instance, has laser surgery to correct retinal detachment and the patient is seen again for a follow up of the surgery in the global period, you would not bill the exam, but you would bill any OCT, fundus photos or any other applicable test performed even if it's for the same diagnosis code. No modifier would be necessary for the testing.

If that same patient was seen in the global period of the retinal surgery to monitor their glaucoma, the exam would be billed with modifier 24, as it would not be related to the surgery. Again, no testing performed on the same date of service would require any modifier.
 
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modifiers

you cannot use those modifiers on a test. They are only use on surgery procedure codes.
 
tovygoldstein said:
My question was regarding the actual requirements for billing the comprehensive eye exam 92014,92004 vs. the intermediate 92012,92002 not in the difference between optometry and ophthalmology.

Thank you.
Click to expand...

Hi Tovygoldstein
I have always used the single system eye exam guideline to determine an intermediate eye exam level from a comprehensive. But unfortunately there is really nothing in the CPT book that states the correct way to evaluate a comprehensive ophthalmological service (92014-92004) from an intermediate ophthalmological service (92012-92002) and it gets difficult. Hopefully one day it will be amended to give the components needed for these CPT codes.
 
Billing Coordinator

Does anyone know if there is a limit as to how many 92014's can be billed in a year? Is there a CMS limitation?

Thanks,

Sue B
 
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