Ophthalmology and Optometry Coding Alert

If your eye care practice employs optometrists, you should separately perform a benchmarking analysis for their claims. One Medicare contractor recently announced some of the most common optometric benchmarking stats that you can use to see where your optometrists fall among the averages.

In November, Part B MAC Palmetto GBA published a Comparative Billing Report (CBR), evaluating their use of E/M codes (99201-99215), ophthalmological services (92002-92014), visual field exams (92081-92083), and scanning diagnostic imaging (92133-92134).

What auditors found: During the review period of April 1, 2014 to March 31, 2015, optometrists’ top-billed codes based on allowed amount were as follows, Palmetto said:

• 92014 — Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits 
• 92004 — Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits 
• 92012 — Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient 
• 99213 — Office or other outpatient visit for the evaluation and management of an established patient…

Extended visual fields (92083) was the most commonly-billed visual field code.

Time spent: Among claims that Palmetto reviewed for optometrists (identified by specialty code 41), average minutes per visit for new patients was 36.40 and for established patients was 17.40 minutes, said Palmetto’s Craig DeFelice during a webinar about the CBR report’s findings.

High level codes: After reviewing billing trends for established ophthalmic exam codes 92012 to 92014, optometrists nationally reported 92014 74 percent of the time—if you reported 92014 more frequently than this, you are on the higher side, according to Palmetto’s data.

SCODI: Among glaucoma patients, 37 percent of beneficiaries nationwide were billed for both a visual field exam and a Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) study within 90 days of one another, DeFelice said—so if you report a higher percentage, you are above the national average.