Ophthalmology Coding, Ophthalmology Practice Tips
Eye Visit Codes (CPT 92002–92014)
Billing codes for ophthalmologists often use CPT codes (Current Procedural Terminology) for eye care services. Depending on whether you’re a new or established patient, different codes apply:
- New Patients
- 92002 – Intermediate eye exam
- 92004 – Comprehensive eye exam (in-depth evaluation)
- Established Patients
- 92012 – Intermediate eye exam
- 92014 – Comprehensive eye exam
These codes are crucial for documenting the level of care provided. They differ based on the complexity of exams and the details examined during each visit.
Refraction Code
- 92015 – Determines your refractive state, essentially your visual prescription, and often accompanies a comprehensive exam.
Special Ophthalmological Service Codes
When diagnostics go beyond standard examinations, such as visual field tests or extended ophthalmoscopy, the codes from 92015–92287 come into play.
Evaluation & Management (E/M) Codes
Sometimes, your visit might involve broader medical insights, especially if there are systemic health concerns influencing eye health. For such cases, E/M codes (99202–99215) may be appropriate:
- 99202-99205 – For new patients
- 99212-99215 – For established patients
Using E/M codes often depends on the complexity of your medical decision-making, or the time invested in your care.
Additional Specific Codes
Some specific procedures also have their own codes:
- 92310–92326 – Related to contact lens fitting
- 92340–92353 – For eyeglass dispensing services
- Cataract surgery (e.g., 66984) and corneal transplants (e.g., 65750)
These codes are highly specific and ensure that the medical services you receive are accurately captured and reimbursed.
Billing Nuances and Documentation
Selecting the right billing codes requires meticulous documentation. You should:
- Match codes with appropriate ICD-10-CM diagnosis codes
- Ensure documentation supports the care level claimed
An example might be a comprehensive exam for a new patient (92004) or using E/M codes if systemic conditions affect eye health.
Key Things to Remember
- Always select the code that matches the complexity of your visit
- Documentation affects everything: the more detail, the better
- Codes and guidelines can update annually, so staying informed is essential for both providers and patients.
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