Wiki Eye codes/EM Codes

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mariawilliams

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I understand that eye codes are used and sometimes identified by some payors as a yearly routine code, but if a patient comes in for yearly CE with concerns of dry eye, the doc uses an eye code. is it wrong to use an eye code if the pt diagnosis turns to dry eye or an additional medical dx that patient warranted at tos during the exam that was scheduled as a yearly complete eye exam? im a little confused.
 
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ODs and OMDs are allowed to use either the 920xx or the 992xx E/M codes. It doesn't matter if the exam results in a diagnosis of some pathology (dry eye, glaucoma, cataracts etc.) or if all is well with no medical diagnosis and it is considered a routine annual exam.

That being said, some insurers "bastardize" the CPT codes and want the OD or OMD to only use the eye codes for annual "wellness" exams and the E/M codes for patients with some pathology.

Tom Cheezum, OD, CPC, COPC
 
mariawilliams said:
I understand that eye codes are used and sometimes identified by some payors as a yearly routine code, but if a patient comes in for yearly CE with concerns of dry eye, the doc uses an eye code. is it wrong to use an eye code if the pt diagnosis turns to dry eye or an additional medical dx that patient warranted at tos during the exam that was scheduled as a yearly complete eye exam? im a little confused.
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No it is not wrong, the eye codes can be used for both medical or routine depending on payer guidelines. I have a reimbursement cheat sheet for my practice.
 
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