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 which to report?
Switch to E/M Codes for Complicated Exams
Experts warn: Don’t choose based on amount of reimbursement. The general rule for CPT codes is to pick the code that most clearly describes the service the ophthalmologist renders. If he is strictly evaluating the function of the eye, report an eye code. If, however, he is evaluating the eye as related to a systemic disease process, report the appropriate E/M code.
Example 1: A new patient presents complaining of blurred vision. The ophthalmologist performs a comprehensive examination, including checking her visual acuity, gross visual fields, ocular mobility, retinas and intraocular pressure. Since this is an examination of the eyes’ function, use 92004.
Example 2: A patient with chronic blepharitis comes in due to a recent foreign-body sensation. During the case history, the patient mentions a recurring headache. The patient had an unremarkable comprehensive exam four...
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