EM Coding Alert

Question: Can we submit 99213 for an office visit and 92065 for vision training on the same date of service?

Hawaii Subscriber

Answer: Yes. The National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits do not bundle vision training code 92065 (Orthoptic training; performed by a physician or other qualified health care professional) with evaluation and management (E/M) code 99213 (Office or other outpatient visit for the evaluation and management of an established patient …). Thus, you can report these two codes together on the same date of service.

Keep in mind: There must be medical necessity for providing the E/M service, and documentation should be separately identifiable in the medical record to support the need and level of service.

Also: Include the recommendations or prescription from the referring physician for the vision training (92065). The claim should also show the referring physician’s name (which may be the actual physician submitting the charge).

Note: The NCCI PTP edits bundle 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) with 92065. However, the edit pair has a modifier indicator of “1,” which means you may override the edit with an NCCI-associated modifier when appropriate.