Eye Code or E/M Code?
Published on Mon Mar 05, 2012
Consult this guide before picking a code for your next office visit.
E/M Codes:
New patient:
Has not seen the physician, or another physician of the same specialty in the same group practice, within the past three years.
- CPT 99201 : Must include problem-focused history, problem-focused exam, and straightforward medical decision making
- 99202: Must include expanded problem-focused history, expanded problem-focused exam, and straightforward medical decision making
- 99203: Must include detailed history, detailed exam, and low-complexity medical decision making
- 99204: Must include comprehensive history, comprehensive exam, and moderate-complexity medical decision making
- 99205: Must include comprehensive history, comprehensive exam, and high-complexity medical decision making
Established patient:
Has seen the physician, or another physician of the same specialty in the same group, within the past three years.
- 99211: May not require the presence of a physician
- 99212: Must have two of three: problem-focused history, problem-focused exam, or straightforward medical decision making
- 99213: Must have two of three: expanded history, expanded exam, or low-complexity medical decision making
- 99214: Must have two of three: detailed history, detailed exam, or moderate-complexity medical decision making
- 99215: Must have two of three: comprehensive history, comprehensive exam, or high-complexity medical decision making
Note:
To help differentiate between different levels of service, see the "Instructions for Selecting a Level of E/M Service" section in the introduction to the E/M codes in the CPT® handbook.
General Ophthalmological Services Codes
New patient:
Has not seen the physician, or another physician of the same specialty 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.
Established patient:
Has seen the physician, or another physician of the same specialty 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.
Intermediate Vs. Comprehensive:
- Intermediate ophthalmological service (92002 or 92012): An evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis.
- Comprehensive ophthalmological service (92004 or 92014): A general evaluation of the complete visual system. It always includes initiation of diagnostic and treatment programs.
Note:
Check with your carrier for additional rules pertaining to intermediate and comprehensive services.