Optometry Coding & Billing Alert

Question: Can you help me break down the guidelines for 92014? How many exam elements must be documented for this code -- all 14?

Indiana Subscriber

Answer: Although your own payers' rules may vary, most insurers require that you include nine of the following elements in a comprehensive exam (92004, Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits; or 92014, ... with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits):

• visual acuity

• gross visual fields

• eyelids and adnexae

• ocular motility

• pupils

• iris

• conjunctiva

• cornea

• anterior chamber

• lens

• intraocular pressure

• retina

• optic disc.

Code an intermediate exam (92002 or 92012) if three of these elements are documented. Apply the lowest level E/M code from the 99201-99215 range (based on the documentation that you have), along with the primary diagnosis and reason for visit or chief complaint, if the optometrist documents fewer than three of these elements.