AAPC - Back to school
Results 1 to 3 of 3

Thread: E/M vs Vision Exam

  1. #1
    Join Date
    Apr 2007
    Iowa City, IA

    Default E/M vs Vision Exam

    AAPC: Back to School
    Does anyone have any information they can supply me on understanding how to distinguish if the claim needs to be submitted using an E/M code or Vision code? I understand it depends on the payer, but what drives it to figure out if it should be E/M visit? Does it only get billed to medical if there is a medical problem?

  2. #2
    Join Date
    Apr 2007
    Fullerton/Buena Park, CA


    Vision codes are mainly used with routine eye visits and widely use with Vision insurances and optometrists.

    Ophthalmologists use both vision & e/m codes. Some medical insurances may not pay the vision code with a medical diagnosis because they have assigned in their system the 92002 - 92014 codes as routine vision only. So you may have to change those codes to e/m instead.
    Jennifer DeWitte, CPC, CPC-P, CPB
    Newport Center Surgical
    Coding & Billing Department

  3. #3
    Join Date
    Apr 2007


    The most important consideration in choosing between 92xxx and 99xxx code is the chief complaint or the reason for the encounter. If pt. Says he/she is here for annual check up. It shd go to routine vision ins. With 92xxx but if pt. Is having some medical issues it shd go to med ins with 99xxx. Having said that most medical ins will pay for 92xxx when billed with medical diag. Though they will not pay for refraction.
    Tiger, CPC, CEMC, CPMA

Similar Threads

  1. Vision with AWV
    By YessieM in forum Billing/Reimbursement
    Replies: 3
    Last Post: 10-06-2014, 02:10 PM
  2. Help... Vision and or Medical?
    By NStone in forum Ophthalmology/Optometry
    Replies: 4
    Last Post: 07-09-2014, 12:22 AM
  3. medical vs. vision
    By riverloverjen38@yahoo.com in forum Ophthalmology/Optometry
    Replies: 4
    Last Post: 04-30-2012, 09:09 PM
  4. Vision by SourceMed
    By Katiemkf in forum Outpatient Facilities
    Replies: 6
    Last Post: 01-26-2012, 09:01 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.