Optometry Coding: Eye Exams, Cataract Surgery and Co-Management
E/M or Eye Code? Choose Wisely With These Documentation Tips
Use the 99200 codes for patients with specific problems — but make sure your documentation backs them up
Optometrists can use their own set of codes for ophthalmic evaluations instead of the evaluation and management codes, but the codes are not interchangeable. Each one describes an optometrist’s services in a slightly different way.
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.
“Optometry and ophthalmology are the only specialties to have their own set of codes to use for exams,” says David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas. “Everyone else has to use the E/M codes.”
Problematic: 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 Optometry Coding & Reimbursement Conference. So how do you decide which one to report?
Switch to E/M Codes for Complicated Exam
Experts warn: Don’t choose based on amount of reimbursement. The general rule for CPT codes is to pick the one that most clearly describes the service the optometrist renders. If he is strictly evaluating the function of the eye, report an eye code. If, however, he is evaluating the ey as related to a systemic disease process, report the appropriate E/M code.
Example 1: A new patient presents complaining of blurred vision. The...
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