Ophthalmology and Optometry Coding Alert

Question: Our office has been coding exams (routine exams) as 92002 and V72.0 when we don't see anything wrong. Would this raise any red flags? Texas Subscriber Answer: No. You may use the general ophthalmological services code 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient) with V72.0 (Special investigations and examinations; examination of eyes and vision). The V code indicates that the patient presented for a routine vision exam or a preventive service. Listing no additional diagnosis tells the insurer that you did not find or treat the patient for any condition or problem. Coverage: If a patient has a medical-only insurance policy, the plan may not cover a claim for 92002 with V72.0 as this diagnosis may be considered routine vision screening. But Blue Cross Blue Shield of Texas will pay this combination for beneficiaries who have a routine vision [...]