Ophthalmology and Optometry Coding Alert

Question: How should we handle it when a patient who has come in for a regular eye exam insists on coming back at a more convenient time to have his eyes dilated for the glaucoma check? Should I code this as one visit after the patient comes back, or are they considered two separate visits?

Maryland Subscriber

Answer: If the patient returns for a dilated follow-up (also known as a dilated fundus examination or DFE), report the ophthalmologist's services -- including both days' work -- as one unit of a comprehensive ophthalmological examination (92004 or 92014). Medicare has stated that a comprehensive ophthalmological examination may take place on more than one day (note the phrase "one or more visits" in the CPT descriptions of those codes).

Keep in mind that some private payers may only pay for the 92004 or 92014 codes once per year because they consider these codes to be annual eye exams. Reporting these codes (including 92002 and 92012) twice within a short period of time may preclude payment and require payment reviews for medical necessity.