Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract Surgery

Choose the Right E/M or Eye Code to Optimize Reimbursement

Use the 99200 codes for patients with specific problems — but make sure your documentation backs them up

Ophthalmology coders can use their own set of codes for ophthalmic evaluations instead of the evaluation and management codes, but the challenge is knowing when to use which set of codes.

Both sets of codes — the E/M codes (99201-99215, Office or other outpatient visit …) and, in the Medicine section of CPT, the general ophthalmological services codes (92002-92014, Ophthalmological services; medical examination and evaluation …) — describe office visits.

There is no set rule regarding when to use the E/M codes or the Medicine section codes, says Jeffrey Restuccio, CPC, CPC-H, principal of Ritecode.com, who led the “Coding and Reimbursement for Ophthalmological Procedures” seminar at the Coding Institute’s 2008 Ophthalmology Coding & Reimbursement Conference. So how do you decide...

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