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Ophthalmology and Optometry Coding Alert

Eye Exams:

92004 and 92014: Can You Code Comprehensive Exams Without Dilation?

Published on Mon May 07, 2012

You can bill for a second visit for a patient refusing dilation if you know these coding tips. If a patient refuses to have his pupils dilated during an eye exam, it creates a dilemma for coders. Follow our expert tips to expand your coding options for patients refusing dilation. Most Medicare carriers assume that a dilated fundus exam will be a part of any comprehensive eye exam you perform and bill with 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits) or 92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits). Without dilation, you cannot perform the fundus exam -- and without the fundus exam, you don't have a comprehensive service. Count 2 Visits as 1 Service CPT states that a comprehensive ophthalmological service [...]
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