Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist has documented a comprehensive office visit for an established patient, but just six months ago I coded the patient's last visit with 92014, the same code that is appropriate according to the documentation for this visit. Can I already submit the same code again?

Alabama Subscriber

Answer: While your concern about how a second eye code in six months will be received by the payer is definitely a valid one, according to general coding principles your responsibility is to code the services provided as accurately as possible without taking into consideration whether the codes will be reimbursed, denied, etc. In other words, you should definitely use 92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) in this situation if it best describes the patient's office visit, because the services performed always determine the proper codes to report.

That being said, your local Medicare carrier may have a frequency edit in its computer system to generate a denial based on medical necessity if the carrier feels that you are billing for a service too often. This will result in YOUR having to send the claim to review with the chart documentation to prove that the level of service was medically necessary.

The E/M codes are also an option for coding office visits, and it may save you time and money to learn your carriers' frequency edits and use an E/M code to report the service. You can use E/M and eye codes interchangeably for ophthalmologic office visits.