Ophthalmology and Optometry Coding Alert

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Here's Your Breakdown of Which Codes Ophthalmologists Are Reporting Nationally

Published on Thu Jun 23, 2016

Once you compare your practice’s benchmarking data over time, you may want to take the next step and compare your coding trends to those of other ophthalmologists in the country.

The following are the codes most often reported by ophthalmologists, according to a Medicare statistical analysis E/M Code Comparison report that was run on Nov. 11, 2015 and released by Part B MAC Palmetto GBA on March 7, 2016. The analysis reviewed claims for specialty code 18 (Ophthalmology) for the time period Jan. 1, 2015 through June 30, 2015, and revealed the following results:

General Ophthalmological Services – New Patient

CODE DESCRIPTOR FREQUENCY

General Ophthalmological Services – New Patient

92002 Ophthalmological services: Medical examination and evaluation with initiation of
diagnostic and treatment program; intermediate; new patient 8.7%

92004 …comprehensive, new patient, 1 or more visits 91.3%

Office or Other Outpatient Services – New Patient

99201 Office or other outpatient visit; New patient; Typically, 10 minutes are spent face-to-face 0.3%

99202 …Typically, 20 minutes are spent face-to-face 3.0%

99203 …Typically, 30 minutes are spent face-to-face 19.4%

99204 …Typically, 45 minutes are spent face-to-face 71.8%

99205 …Typically, 60 minutes are spent face-to-face 5.4%

Initial Hospital Care – New or Established Patient

99221 Initial hospital care; Typically, 30 minutes are spent at the bedside 24.9%

99222 …Typically, 50 minutes are spent at the bedside 38.2%

99223 …Typically, 70 minutes are spent at the bedside 36.9%

Subsequent Hospital Care

99231 Subsequent hospital care; Typically, 15 minutes are spent at the bedside 27.1%

99232 …Typically, 25 minutes are spent at the bedside 51.2%

99233 …Typically, 35 minutes are spent at the bedside 21.7%

Emergency Department Services – New or Established Patient

99281 Emergency department visit; Usually, the presenting problems are self-limited or minor 3.8%

99282 …Usually, the presenting problems are of low to moderate severity 14.1%

99283 …Usually, the presenting problems are of moderate severity 35.1%

99284 …Usually, the presenting problems are of high severity 31.9%

99285 …Usually, the presenting problems are of high severity and pose an immediate significant
threat to life or physiologic function 15.0%

General Ophthalmological Services – Established Patient/Office or Other Outpatient Services – Established Patient (Government data combines these together)

92012 Ophthalmological services; intermediate, established patient 29.8%

92014 …comprehensive, established patient, 1 or more visits 46.4%

99212 Office or other outpatient visit; Established patient; Typically, 10 minutes are spent face-to-face 3.0%

99213 …Typically, 15 minutes are spent face-to-face 12.3%

99214 …Typically, 25 minutes are spent face-to-face 7.7%

99215 …Typically, 40 minutes are spent face-to-face 0.7%

Source: Palmetto GBA Comparative Billing Report for E/M Services, http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8PHGGS7435.