Ophthalmology and Optometry Coding Alert
Know Your Limits
Question: Are there limits regarding how often I should use office visit codes for my patients? Illinois Subscriber
Answer: Some carriers have frequency requirements for comprehensive eye codes and for E/M codes.
Most limit 92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) to once every six months without additional explanation of the medical necessity for comprehensive exams that are performed more frequently.
For E/M codes, frequency limits tend to be restricted to levels four and five. A denial based on too frequent performance doesn't mean nonpayment, but it does mean the claim will go through the appeals process.
If you bill for a comprehensive eye exam more frequently than the carrier allows, bear in mind that documentation will probably be requested.
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