Ophthalmology and Optometry Coding Alert
Clarification:
Comprehensive Exams Don't Always Include Dilation
Published on Mon Nov 03, 2008
A Reader Question in Ophthalmology Coding Alert, Vol. 11, No. 7, "Distinguish Between 92012 and 92014," stated, "The main difference between 92012 and 92014 is that 92014 requires dilation unless medically contraindicated." In fact, the CPT definition of a comprehensive ophthalmological service (92004 and 92014) says that it often (not always) includes an examination with dilation (cycloplegia or mydriasis). However, many insurance carriers do have their own local coverage policies that require a dilated exam as part of a comprehensive exam (as opposed to an intermediate exam, 92002 or 92012). Best bet: When in doubt, check with the individual carrier.
Other Articles in this issue of
Ophthalmology and Optometry Coding Alert
- CPT 2009 Update:
Start Using 65756 for Endothelial Keratoplasty in January
Also: Include graft prep in other corneal transplant codes. If you've been frustrated by a [...] - Look to Modifiers KX, EY for Keys to DME Reimbursement
Keep medical necessity distinct from patient preference in documentation.If you're providing refractive lenses for cataract [...] - DME MACs Usually Won't Cover These
There are a few HCPCS codes that your DME MAC will never cover. Make sure [...] - E/M Corner:
Use Inside Info to Prevent HPI Rule Hunt
In CMS's eyes, this element is your ophthalmologist's duty.You're not alone if you've read and [...] - You Be the Coder:
Avastin Injection
Question: Should I be reporting J3490 for Avastin for all carriers, including Medicare? This is [...] - Reader Questions:
Forget Modifiers for Bilateral VF
Question: As a retina office, we occasionally do visual fields. However, when I report 92082-LT [...] - Reader Questions:
Describe Follow-Up Visits Accurately With V Codes
Question: If a patient receives treatment and the condition was resolved, which ICD-9 code should [...] - Reader Questions:
Link 92250 to Ophthalmic Manifestation
Question: We submitted a claim for 99204 and 92250 to Medicare. The diagnosis code for [...] - Clarification:
Comprehensive Exams Don't Always Include Dilation
A Reader Question in Ophthalmology Coding Alert, Vol. 11, No. 7, "Distinguish Between 92012 and [...]
View All
