Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist documented a comprehensive office visit for an established patient, but just five 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?

Codify 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, 1 or more visits) in this situation if it best describes the patient's office visit and supports medical necessity, because the services performed always determine the proper codes to report.

Having said that, your local Medicare carrier or private payer 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. 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 when it's most appropriate.