Optometry Coding & Billing Alert
Make Sure Your E/M Documentation Measures Up
Use these handy definitions to determine if an E/M or eye code is more appropriate When you-re preparing to code an office visit, documentation is the key to being able to justify the level of code you report. Use this chart to help determine which code -- and which level -- fits the scenario. E/M Codes New patient Established patient General Ophthalmological Services Codes Established patient
Has not seen the optometrist, or another optometrist in the same group practice, within the past three years.
- 99201: Problem-focused history, problem-focused exam, and straightforward medical decision-making
- 99202: Expanded problem-focused history, expanded problem-focused exam, and straightforward medical decision-making
- 99203: Detailed history, detailed exam, and low-complexity medical decision-making
- 99204: Comprehensive history, comprehensive exam, and moderate-complexity medical decision-making
- 99205: Comprehensive history, comprehensive exam, and high-complexity medical decision-making.
Has seen the optometrist, or another optometrist in the same group, within the past three years.
- 99211: May not require the presence of a physician
- 99212: Two of three: problem-focused history, problem-focused exam, or straightforward medical decision-making
- 99213: Two of three: expanded history, expanded exam, or low-complexity medical decision-making
- 99214: Two of three: detailed history, detailed exam, or moderate-complexity medical decision-making
- 99215: Two of three: comprehensive history, compre- hensive exam, or high-complexity medical decision-making.
Note: To differentiate between different levels of service, see -Instructions for Selecting a Level of E/M Service- in the E/M codes- introduction in the CPT book.
New patient
Has not seen the optometrist, or another optometrist in the same group practice, within the past three years.
- 92002 -- Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
- 92004 -- - comprehensive, new patient, one or more visits.
Has seen the optometrist, or another optometrist in the same group, within the past three years.
- 92012 -- Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
- 92014 -- - comprehensive, established patient, one or more visits.
According to CPT guidelines, an intermediate ophthalmological service is -an evaluation of a new or existing condition complicated with a new diagnostic or management problem.-
A comprehensive ophthalmological service -always includes initiation of diagnostic and treatment programs. This may include:
- Prescription of medication, lenses and other therapy - Arranging for special ophthalmological, diagnostic or treatment services
- Consultation
- Laboratory procedures
- Radiological services as may be indicated.
Note: Check with your carrier for additional rules pertaining to intermediate and comprehensive services.
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