Optometry Coding & Billing Alert
Don't Push Limits on E/Ms and -25
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Question: Let's say I have a patient with eye pain (379.91), and I find a lash that is irritating the cornea (374.05) and I remove the lash with forceps (67820). Are we able to charge an intermediate exam (92002 or 92012) if we do a history, acuities, and slit lamp in the process of finding the lash that was causing the problem? Answer: Whether you can justify separate payment for an intermediate exam at the same patient encounter as epilation will depend on your documentation -- and whether it supports payment for a separate and distinct service.
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If you do decide to report an intermediate exam code (92002 or 92012, depending on whether the patient is new or established), you must be sure that all of the necessary components of an exam are documented. Because carriers already reimburse 67820 at a relatively high rate, and payment is generally very prompt, most optometrists choose not to separately report an exam because of the extensive documentation requirements associated with these examination codes.
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