EM Coding Alert

Question: Our new office manager is facing some confusion about what codes we would report for an office visit. Can we bill 92002 and 99204 together if the physician sees the patient for a general ophthalmological service and then also addresses cataracts, requiring an E/M code, on the same day?

Arizona Subscriber

Answer: No, you can’t report these two codes together because they indicate the same type of service — a new patient visit. Ophthalmology and optometry are the only specialties that have their own options to report office encounters, and for each encounter, you must choose whether to opt for an E/M code or an eye code.

From the E/M code range for new patient visits, you could choose 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making …) if the documentation supports the full service. On the other hand, your ophthalmology options are: 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient) and 92004 (… comprehensive, new patient, 1 or more visits).

Choosing between the E/M and eye examination codes can be a little more challenging to pinpoint, but generally if your ophthalmologist just evaluates the eyes’ function or performs a routine exam, you would choose an ophthalmological code: 92002 or 92004.

For more complicated cases, like with patients who present with chronic conditions, new problems, and injuries, you can look to an E/M code. Remember, if you do choose an E/M code over an ophthalmology code, the encounter must meet the more-detailed documentation standard of E/M codes.

Note: Different payers may have different rules about policies for using E/M codes versus eye codes, so you can check with your payer if you are unsure.