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Ophthalmology Coding question: “I have a question in ophthalmology outpatient clinic. How will you code E&M in ophthalmology?

Are there any special codes other than 99201 to 205 or 211 to 215 for new and established outpatients? Is E&M coding different for ophthalmology compared to basic E&M coding? Can someone explain to me with some reference about determination of MDM and E&M? I’m getting a lot of queries about MDM from the providers/physicians. Thank you.”

So yes, coding for ophthalmology is the only specialty where they can choose to use the regular E&M codes or the special eye codes that are in the medicine section. So I’ve got an answer sheet prepared here. I did a little screen capture from a supercoder and you can see 92002 to 004 are new patients – ophthalmological services and procedures. These are the eye codes. It’s the same as regular E&M and that they’re divided by new versus established. There’s only two codes for new and there’s only two codes for established. The difference is the level , so it’s intermediate versus comprehensive.

Ophthalmology Coding – Video

Okay so here it is in my CPT book. So ophthalmological services, that’s basically your eye codes. Medical coding exam and evaluation with initiation of diagnostic and treatment programs. So you do need to have that, that’s before the semi-colon. Intermediate, comprehensive. So these are the two new code, new patient codes. And then we’ve got 92012 and 014, these are the intermediate for established patients and comprehensive for established patients. Again, it’s with initiation or continuation of diagnostic and treatment program.

Ophthalmologists can choose to use regular E&M or these codes. Here are some definitions. If you choose to use the eye codes just like any other code in CPT, you need to meet the definitions, your documentation needs to meet it in order to be able to use those codes.

So intermediate says ‘describes an evaluation of a new or existing condition, complicated with a new diagnostic or management problem, not necessarily related to the primary diagnosis.’ And so they do things like a history, general medical observation. They look at the external ocular and adnexal exam and other diagnostic procedures as indicated. And if you’ve never had an eye exam, you know how they put those drops in and sometimes, you can’t see very well after? That’s just mydriasis for the ophthalmoscopy.

So let me give you some examples. Right from your CPT book, these definitions. Then we go into comprehensive and it says it describes a general evaluation of the complete visual system. And down here, it always includes initiation of diagnostic and treatment programs. So in the research I did, they really emphasized this. If you’re going to use these comprehensive codes which are more money, higher RVU to really make sure you have that documented.

And this was actually taken from… I think my CPC-H textbook and I liked how they did the comparison. I’m very visual as many of you know and to do side by side comparison. So intermediate versus comprehensive eye codes. They both require a history. They both require a general medical observation. Now the intermediate does an external ocular and an adnexal exam. So they’re looking at the surrounding structures to the eyeball itself. And then comprehensive, they’re doing an external and the scope of the eye. Intermediate, they do other diagnostic procedures and then gross visual fields. Intermediate, they do a basic sensory motor exam. Intermediate may include those eye drops and the comprehensive often includes biomicroscopy exam and they do this cycloplegia or these drops. And they do tonometry so they measure the pressure of the eye so you can see it’s definitely more involved. And then again, always include initiation of diagnostic and treatment program. You need to have that to be a comprehensive.

Now I found a lot of great websites for you to go to to really get as much detail as you want, if you’re working for an ophthalmologist or if you want to give them the references because he did ask, “with references” which is good. You should always back it up. It shouldn’t just be Laureen said or Alicia said. You know, you want to know… you want to have it backed up.

This is an article… this is one of the advantages of subscribing to Supercoder and this is a bonus for thinking of starting to include in our student packages for the more full blown medical coding courses. You get access to these types of articles bundled in. Now I’m seeing this because I’m logged in but sometimes, I give you little teasers. And you could order articles you know, one off by Supercoder. But they just go in and they explain it really… I think, in a very basic way, the office visits versus the eye codes. Don’t assume they’re interchangeable and goes in and says, “Resist the temptation of higher RVUs. What it’s about is making sure you’ve got the documentation to back it up.”

Now a free website here are the Using the Eye Codes for Ophthalmic Visits and this is from Corneal Consultants. Now it’s a bit dated obviously, 2009, but the codes are the same. There hasn’t been much changes to the eye codes. So the lesson I got out of this was this nice table. Now the RVUs are probably different right now but it gives you an idea. If you look at the left side of the table are new patient codes and the right side are established. And then the first two rows are the eye codes compared to the last 5 rows which are the regular E&M codes. And what this bears out is that the RVUs are pretty similar. For a 92002 works out to be similar to 99202 so level 2 and regular E&M. So the comprehensive ones are a little bit higher RVU which is what’s attractive to the physicians and why they want to code it.

So at any rate, that is what you have to take into consideration. They’re allowed to use whichever works best for them. But again, make sure they have the documentation to back it up. But a lot of good… another one is this American Ophthalmic… oh no, American Academy of Ophthalmic Executives. And this is a really cool page. They have a whole page dedicated to coding and reimbursement for ophthalmology. So check this out. They’ve got stuff about new coding changes, coding tools so that will be on the answer sheet as well.

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READ THIS LATER! DOWNLOAD THE PDF >> CLICK HERE <<
2016-11-20T23:38:29+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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