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E&M vs. Eye Exam Codes

  1. Default E&M vs. Eye Exam Codes
    Medical Coding Books
    Good Morning,

    Vermont Medicaid has placed a restriction on 92002/4 92012/4 eye exam codes. However, my understanding was that the eye exam service was not fundamentally uncodable as an E&M service using the 99--- office visit codes.

    My understanding is that the 92--- codes exist to compensate for the fact an eye exam usually results in a very restricted review of systems, resulting in an artificially reduced level of E&M service. Thus, it is not incorrect coding that providers bill their eye exams as the 99--- codes, it is just in their best interest to use the 92--- codes, since they do not have to do a comprehensive review of systems when that is not a major part of the examination.

    I would like to request feedback on this, if anyone can confirm or deny my understanding of the coding.

    Chris Lyon

  2. Default E/M vs Eye code
    We use the 1997 Eye Auditing tool for the E/Ms. Eye specific exam. We use both E/M and eye codes for the visits, whichever is more applicable.

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