Optometry Coding & Billing Alert

Question: Our optometrist saw a patient who came in after a work injury affecting his vision. Which codes should I use to report the service to workers- comp?


Alabama Subscriber


Answer: For the optometrist's evaluation of the injury, although workers- compensation (WC) insurers- rules vary, you should generally use the standard evaluation and management codes (99201-99215). CPT dictates that 99455 (Work related or medical disability examination by the treating physician ...) and 99456 (Work related or medical disability examination by other than the treating physician ...) -are used to report evaluations performed to establish baseline information prior to life or disability insurance certificates being issued.- So avoid these codes when evaluating work-related injuries.

If the optometrist diagnosed a problem or injury, you should report the appropriate diagnosis code for that condition first, followed by the E codes to describe how the injury occurred.

E codes describe external causes of injuries or accidents and support the work-related nature of certain injuries to differentiate workers- compensation care from non-WC care.