Wiki Coding a refraction with a 92014

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kellyshanks

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Maryville, Il
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This is a big debate in our office right now and I would love some references to back me up, am having a hard time finding any.
Patient is seen and there are enough elements in the exam to use a 92014 (we only use eye codes)- IF we use the prescribing new eyeglasses as the element for initiating new treatment. I have a coder arguing that we cannot use the prescribing of new glasses as an element IF we also code the refraction. I know this is not true, but I cannot find documentation to support this. Please help!
Thanks
Kelly
 
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Are you coding to medical insurance? Most medical plans do not pay for the refraction. When I worked for an optometrist, we billed the 92014 to the insurance and the patients paid OOP for the refraction (92015). My understanding is that determining the patient's refractive state is not considered part of a comprehensive optometric exam (i.e glaucoma screening, retinal check etc.)
 
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The 92015 is not an exam element for either the 92 or 99 codes. Never has been. I don't have any formal documentation but do know that the only exam codes which do include the refraction as an element of the exam are the "S" codes which are hardly ever used except for internal tracking purposes for most office who use them.

Tom Cheezum, OD, CPC, COPC
 
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