Optometry Coding & Billing Alert
Weigh Eye Exam vs. Consultation Coding
Question: We had a 55-year-old patient with type 1 diabetes come in presenting with a chief complaint of blurred vision (both distance and near). The patient's primary care physician told her she needed an eye exam. 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: There is no specific ICD-9 code for diabetic macular edema. You should report 362.01 (Background diabetic retinopathy) to cover both listed diagnoses in the chart.
Optometry Coding & Billing Alert
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