Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Can we use the eye codes (92002-92014) to bill Medicare if we do not do an initiation of diagnostic and treatment plan, as required in CPT?

Oregon Subscriber


Answer: HCFA has a broad definition of what constitutes a diagnostic and treatment plan. Even though it doesnt pay separately for refractions, it says a refraction is part of a treatment plan. That would be enough to qualify for an intermediate eye code.

CPT 1998 included two extra words in the introduction to the eye codes. It said other diagnostic procedures were required as indicated. That could mean no other diagnostic procedures were required, if the physician felt none were indicated. CPT 1999 dropped those two critical words. HCFA dealt with this editorial omission by saying a refraction could qualify under the phrase other diagnostic procedures.

Many ophthalmology coders use E/M codes for rechecks, for example, because they do not need to worry about diagnostic procedures. If you view a refraction as a diagnostic procedure (which it is, albeit a noncovered one), you could use the eye codes. But if you are uncomfortable with that, use the E/M codes.