Ophthalmology and Optometry Coding Alert

You saw how three ophthalmologists would fare under the proposed E/M payment changes —now check out what the impact would be to three optometrists whose data we sampled. Using the current E/M payment levels and comparing them to the proposed new payments, we calculated the following impact on these optometrists:

Impact to Practice 1: Optometrist in New Jersey:

• 99212: Billed 15 times in one year – worth $675 today, worth $1,395 under proposal
• 99213: Billed 180 times in one year – worth $13,500 today, worth $16,740 under proposal
• 99214: Billed 36 times in one year – worth $3,924 today, worth $3,348 under proposal
• 99215: Billed 4 times in one year – worth $592 today, worth $372 under proposal

Total Difference: This physician earned $18,691 for these four codes under today’s payment structure, and would earn $21,855 under the proposal. This physician would see $3,164 more pay under the proposal for these four codes.

Impact to Practice 2: Optometrist in Iowa:

• 99212: Billed 12 times in one year – worth $540 today, worth $1,116 under proposal
• 99213: Billed 36 times in one year – worth $2,700 today, worth $3,348 under proposal
• 99214: Billed 1,059 times in one year – worth $115,431 today, worth $98,487 under proposal
• 99215: Billed 7 times in one year – worth $1,036 today, worth $651 under proposal

Total Difference: This optometrist earned $119,707 for these four codes under today’s payment structure, and would earn $103,602 under the proposal. This doctor would see $16,105 less pay under the proposal for these four codes.

Impact to Practice 3: Optometrist in Nevada:

• 99212: Billed 46 times in one year – worth $2,070 today, worth $4,278 under proposal
• 99213: Billed 538 times in one year – worth $40,530 today, worth $52,824 under proposal
• 99214: Billed 22 times in one year – worth $2,398 today, worth $2,046 under proposal
• 99215: Billed 6 times in one year – worth $888 today, worth $558 under proposal

Total Difference: This physician earned $45,886 for these four codes under today’s payment structure, and would earn $59,706 under the proposal. This optometrist would see $13,820 more pay under the proposal for these four codes.