Ophthalmology and Optometry Coding Alert

Question: Can we submit 99213 for an office visit and 92065 for vision training on the same date of service?

Texas Subscriber

Answer: Vision training code 92065 (Orthoptic and/or pleoptic training, with continuing medical direction and evaluation) is not bundled with E/M code 99213 (Office or other outpatient visit for the evaluation and management of an established patient &). You can report these two codes together on the same date of service.

Keep in mind: There must be medical necessity for providing the E/M service and documentation should be separately identifiable in the medical record to support the need and level of service. Some carriers or private payers may require the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service.

However: Note that 92065 is bundled with 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician &).

Also: Include the recommendations or prescription from the referring physician for the vision training (92065). The claim should also show the referring physicians name (which may be the actual physician submitting the charge).