Ophthalmology and Optometry Coding Alert
Take the Work Out of WC Claims
Alabama Subscriber
Answer: For the ophthalmologist's evaluation of the injury, although workers- compensation (WC) insurers- rules vary, you should generally use the standard E/M codes (99201-99215). CPT dictates that 99455 (Work related or medical disability examination by the treating physician ...) and 99456 (Work related or medical disability examination by other than the treating physician ...) -are used to report evaluations performed to establish baseline information prior to life or disability insurance certificates being issued.- So avoid these codes when evaluating work-related injuries.
If the ophthalmologist diagnosed a problem or injury, you should report the appropriate diagnosis code for that condition first, followed by the E codes to describe how the injury occurred.
E codes describe external causes of injuries or accidents and support the work-related nature of certain injuries to differentiate workers- compensation care from non-WC care.
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