Optometry Coding & Billing Alert
Weigh Eye Exam vs. Consultation Coding
Question:
Other than the diabetes, she's in good health, but the optometrist diagnosed mild non-proliferative diabetic retinopathy and mild diabetic macular edema. He ordered fundus photographs and an extended threshold fields exam. How should I report all these services? Should I start with a consultation code?
New York Subscriber
Answer:
You may only report a consultation code if the primary care physician has specifically requested your optometrist's opinion, advice, and recommendations for treatment. This does not seem to be true in your scenario.The optometrist may report an E/M code (99201-99215) depending on the service level he provided and documented or one of the ophthalmology service codes (92002-92014), again based on the services performed and documented. Next, report 92250 (Fundus photography with interpretation and report) for the fundus photography the optometrist decided to perform.
Also, code the threshold fields exam using 92083 (Visual field examination, unilateral or bilateral, with interpretation and report; extended examination ...).
Diagnosis roundup:
You should report 362.01 (Background diabetic retinopathy) and 362.07 (Diabetic macular edema) to cover both of the listed diagnoses in the chart.Optometry Coding & Billing Alert
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