Wiki Initiation of a diagnostic and treatment program Comp vs. Intermediate

[JocelynHintze]

I am hoping someone can help me answer some questions regarding the coding of Ophthalmology codes 92002, 92004, 92012, ,92014. The descriptions shown below for the new patient codes includes an initiation of a diagnostic and treatment program; whereas, the established patient codes includes an initiation or continuation of a diagnostic and treatment program. What is conflicting and unclear is the definitions (2014 CPT book page 536) for Intermediate ophthalmological services does not include initiation of a diagnostic and treatment program. And, the definition for the Comprehensive ophthalmological services states ?It always includes initiation of a diagnostic and treatment program?.

Our Coding Department and providers have always required an initiation of a diagnostic and treatment program when coding the Comprehensive Eye Codes, and have not for the Intermediate Codes. Also, in reading articles related to these codes many of them indicate that the initiation of a diagnostic and treatment plan is required for the comprehensive and not a requirement for the intermediate. However, this was recently questioned as the descriptions of the codes indicate that the new patient codes require this and the established patient codes could include either initiation of a diagnostic and treatment program or a continuation of a diagnostic and treatment plan.

Please let me know if anyone has any insight as to whether the Intermediate Eye Codes also Require an initiation of a diagnostic and treatment program.

CODE DESCRIPTIONS:
92002 ? Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92004 ? Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits

92012 ? Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92014 ? Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits

Initiation of diagnostic and treatment program Includes the prescription of medication, and arranging for special Ophthalmological services, or in which special treatment is given. Special ophthalmological services may be reported in addition to the general ophthalmological services or evaluation and management services.

 

[fhromeo30]

Initiation or Continuation

Hi

For my providers, and we use EncoderPro online, it states the intermediate exams can have an initation OR continuation of a treatment plan; i.e. for cataract or DME. I don't differentiate the intermediate and comprehensive based on treatment plan--I select based on the exam. (Which in my experience is harder to get them to document all the required elements to get the comprehensive exam than to state their new or continuation of a treatment plan)

Did this help?

 

[jbrightw]

CPT description for this code should include continuation (Not only initiation), since mostly the comprehensive exam will be completed in the second visit which is a continuation of the initiated visit, That's what I feel.

'92004 ? Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits'

Brightwin

 

[Tiger]

Refractive prescription is included in "initiation and continuation o treatment" So if the doctor does a refraction the condition is satisfied.

 

[huntersmum]

what is considered.....

a treatment/diagnostic plan? We have just taken on a ophthalmology clinic and we are stumped. Is it warm washcloths and over the counter tears? Is there a reference out there that better clarifies this? Any help would be appreciated! Thanks in advance.