Optometry Coding & Billing Alert

Don't code 99201-99215 separately unless the service can stand alone

If you-re automatically billing an E/M code along with the advanced diagnostic tests you perform, expect to see some denials. Unless the E/M is for a different problem than the test is addressing, it's included in the testing service.

-This is an area that optometrists tend to be confused about,- says David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas. -An E/M is not automatically billed with any advanced testing like fundus photos (92250) or visual fields (92081-92083). The E/M code must be able to stand alone without the presence of the other testing.-

Example: Following a comprehensive exam, an optometrist makes a diagnosis of preglaucoma (365.01, Borderline glaucoma [glaucoma suspect]; open angle with borderline findings). The patient returns to the office a week later for more testing.

-At this second visit, an E/M code is not automatically billed as an add-on to the other testing,- Gibson says. -Nor can you bill an E/M visit for the time you took to explain the results of the test. The E/M visit would only be billable if the doctor evaluated a new problem or re-evaluated the existing problem just as if he had not performed the other testing.-

Exception: If the optometrist rechecked acuities and intraocular pressures, he could bill 99212 (Office or other outpatient visit for the evaluation and management of an established patient -), -with the same requirements of history, review of systems, etc., as any other E/M visit,-  Gibson says.