Wiki MDM for glasses and/or contact lenses?

[cierras]

I have a provider who billed a 99204 and used prescription drug management for the RX of contact lenses. Is this acceptable? I can't find anything on it, besides contacts/glasses are considered a medical device under FDA and require a prescription.

 

[TThivierge]

Hi Cierras
Check in the section of CPT book in middle of manual about page 661 . Office visits for eyes start with CPT 92002 till 92014. Add modifier 25 if eye test given. But use CPT 92015 if give prescription of glasses and office visit.. More ophthalmology visits till CPT 92002 to CPT 92549. Ophtham. visits start with CPT 92002 . Contact lens use CPT 92071 or CPT 92071 whereas fitting glasses use CPT 92340. Ensure specify if for bilateral eyes(OU) affected or left (OS) or right eye (OD.) But be careful cause some insurance plan will only let you use the eye CPT codes once a year, then use Evla Mgmt CPT codes. as CPT 92004 modifier 25 and then CPT for eye glasses per documentation given.
I hope this data helps you
Lady T

 

[Cheezum51]

That isn't correct. It has to be prescription MEDICATIONS, not prescription lenses. Did the doctor only code refractive codes for the 99204? If so, that wouldn't qualify as a medical visit.

Tom Cheezum, OD, CPC, COPC