Opthalmology Coding/Doc

leeannatk

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I am Compliance Administrator for a large multispecialty practice and feel pretty comfortable with most of the specialties. But a question has come up for me as i review our Eye group for the first time.
We do lots of ROP (retinopathy of prematurity) exams in the hospital. I am finding that the docs are documenting the exam (92226) exactly as required with the drawing, etc. But this is their only documentation and includes the drawing and then the impression documentst he staging and when the next exam will be. My problem is that they are also billing an E/M code - generally 99233. But I see nothing in the documentation that supports the E/M code.
Am I missing something or should they bill only the procedure (92226) code?

Thanks in advance your guidance.

Lee Ann Atkinson, CPC, CHA
 

Julie Davis

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If they are not meeting the guidelines for an additional exam, then they should not be coding an additional E/M code. It may be that they are doing the additional work but not documenting it appropriately, and that would be a different discussion to have with them.
 
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