Last years CPT revised the guidelines for intermediate ophthalmological services (92002, 92012) to differentiate between routine ophthalmoscopy and extended ophthalmoscopy. The language was also changed to clarify that the service of refraction and prescription of lenses is not included in the eye codes, and is separately billable with 92015. What, then, is included in 92002 and 92012, and what is included in comprehensive ophthalmological services (92004, 92014)?
It depends on your carrier, says Raequell Duran, president of Santa Barbara, CAbased Practice Solutions, which specializes in ophthalmology consulting in billing and collections. Currently, there is not a national policy for the documentation requirements for the eye codes, says Duran. When a national policy does not exist the local carrier has the authority to create its own policy.
Even whether or not dilation is required in order to bill a comprehensive eye exam is up to the carrier. In some states, a dilated examination is required to bill a comprehensive exam, says Duran.
Its very important that you contact your carriers provider relations department to find out what their requirements are, explains Duran. You will see below how widely policies can differ in terms of these codes.
Intermediate ophthalmological services are for evaluation of a new or existing condition complicated with a new diagnostic or management problem, according to CPT. The new condition doesnt necessarily have to relate to the primary diagnosis. Intermediate services include history, medical observation, external ocular and adnexa examination, and other diagnostic procedures as indicated.
The language new or existing condition complicated with a new diagnostic or management problem has been incorporated by some Medicare carriers as a requirement for intermediate ophthalmological services. In those states, if you cant satisfy this requirement, you need to use the E/M codes to bill the service , explains Duran.
In Texas, the Medicare carrier recognizes specific examination elements. To bill for a comprehensive exam (92004 or 92014), you must perform nine or more of the specified elements, including a dilated fundus examination. To bill for an intermediate exam (92002 or 92012), you need to perform eight or fewer of the specified elements.
The 11 elements on the Texas Medicare carriers list for the eye codes are:
Visual acuity
Basic visual fields
Eyelids and adnexa
Ocular motility
Pupils and iris
Cornea
Anterior chamber
Lens
Intraocular pressure
Optic disk
Retina (including vitreous, macular, periphery, and vessels)
