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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.
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