By Stephanie Adams Ophthalmology Coding
Understanding ophthalmology CPT (Current Procedural Terminology) codes is essential for healthcare providers, medical coders, and patients seeking to understand their eye care billing. These standardized codes help ensure accurate billing and communication between healthcare providers and insurance companies. This comprehensive guide covers the most commonly used ophthalmology CPT codes, explaining what each procedure involves and when it’s typically used.
What Are CPT Codes 92002-92014 Used For?
CPT codes 92002-92014 represent comprehensive eye examinations and are among the most frequently used codes in ophthalmology practices. These codes cover different levels of eye exams based on the complexity and comprehensiveness of the examination performed. Code 92002 is used for intermediate ophthalmoscopic examinations for new patients, while 92004 represents comprehensive ophthalmoscopic examinations for new patients. For established patients, 92012 covers intermediate examinations and 92014 covers comprehensive examinations. These examinations typically include visual acuity testing, refraction assessment, external eye examination, ophthalmoscopy, and evaluation of the anterior and posterior segments of the eye. The distinction between intermediate and comprehensive examinations depends on the extent of the evaluation and the clinical decision-making involved.
What Are CPT Codes 99213-99214 Used For?
CPT codes 99213-99214 are evaluation and management (E&M) codes used for medical visits in ophthalmology practices. These codes are not specific to ophthalmology but are used across all medical specialties to describe office visits for established patients. Code 99213 represents a level 3 office visit for an established patient, typically involving a problem-focused or expanded problem-focused examination with straightforward to low complexity medical decision-making. Code 99214 represents a level 4 office visit for an established patient, involving a detailed examination with moderate complexity medical decision-making. In ophthalmology, these codes might be used for follow-up visits related to glaucoma management, diabetic retinopathy monitoring, or other ongoing eye conditions that require medical management rather than surgical intervention.
What Is CPT Code 92134 Used For?
CPT code 92134 is used for Optical Coherence Tomography (OCT) scanning of the retina. This diagnostic imaging procedure provides high-resolution cross-sectional images of the retinal layers, allowing ophthalmologists to detect and monitor various retinal conditions. OCT retinal scanning is particularly valuable for diagnosing and monitoring macular degeneration, diabetic macular edema, macular holes, epiretinal membranes, and other retinal pathologies. The procedure is non-invasive and uses light waves to create detailed images of the retinal structure. The technology helps clinicians assess retinal thickness, detect fluid accumulation, and monitor treatment response over time. This code includes both the technical component of performing the scan and the professional component of interpreting the results.
What Is CPT Code 92133 Used For?
CPT code 92133 is used for Optical Coherence Tomography (OCT) scanning of the optic nerve head. This diagnostic test provides detailed cross-sectional images of the optic nerve and surrounding tissues, which is crucial for detecting and monitoring glaucoma and other optic nerve disorders. The OCT optic nerve scan measures the thickness of the retinal nerve fiber layer (RNFL) and can detect early signs of glaucomatous damage before visual field defects become apparent. This test is essential for glaucoma diagnosis, progression monitoring, and treatment evaluation. The procedure helps ophthalmologists assess optic nerve health, measure cup-to-disc ratios, and track changes over time. The detailed imaging provides objective measurements that complement clinical examination and visual field testing in comprehensive glaucoma care.
What Is CPT Code 92083 Used For?
CPT code 92083 is used for extended visual field examinations, also known as perimetry testing. This diagnostic procedure maps the patient’s complete field of vision to detect blind spots, visual field defects, and other abnormalities that may indicate various eye conditions. Extended visual field testing is crucial for diagnosing and monitoring glaucoma, as it can detect peripheral vision loss that patients may not notice in their daily activities. The test is also used to evaluate neurological conditions affecting vision, such as stroke, brain tumors, or other central nervous system disorders. During the examination, patients look at a central target while lights of varying intensity are presented throughout their peripheral vision. The test produces a detailed map showing areas of normal vision, reduced sensitivity, and blind spots, providing essential information for treatment planning and monitoring disease progression.
What Is CPT Code 92250 Used For?
CPT code 92250 is used for fundus photography, a diagnostic imaging procedure that captures detailed photographs of the interior surface of the eye, including the retina, optic disc, macula, and blood vessels. Fundus photography is an essential tool for documenting and monitoring various retinal conditions, including diabetic retinopathy, macular degeneration, hypertensive retinopathy, and other retinal diseases. The photographs provide a permanent record of the retinal appearance, allowing for comparison over time to track disease progression or treatment response. This documentation is particularly important for patients with diabetes or other systemic conditions that can affect the retina. The procedure involves dilating the pupil and using specialized cameras to capture high-resolution images of the retinal structures.
What Is CPT Code 76519 Used For?
CPT code 76519 is used for A-scan ultrasound biometry of the eye. This diagnostic procedure uses ultrasound technology to measure the length of the eyeball and other important ocular dimensions, which is essential for calculating intraocular lens (IOL) power before cataract surgery. A-scan ultrasound is a critical component of pre-operative cataract surgery planning, as it provides precise measurements of the eye’s axial length, anterior chamber depth, and lens thickness. These measurements are used in mathematical formulas to calculate the appropriate power of the IOL that will be implanted during cataract surgery to achieve the desired refractive outcome. The procedure is also used to detect and monitor certain eye conditions, such as tumors or other abnormalities within the eye. The ultrasound probe is gently placed on the eye’s surface or eyelid to obtain accurate measurements.
What Is CPT Code 92136 Used For?
CPT code 92136 is used for IOL Master biometry, an advanced optical measurement device that provides precise measurements for intraocular lens calculations. This non-contact technology uses partial coherence interferometry to measure various eye parameters with exceptional accuracy. The IOL Master is considered the gold standard for biometry measurements in cataract surgery planning. It measures axial length, anterior chamber depth, corneal curvature, and white-to-white distance without touching the eye, making it more comfortable for patients than traditional ultrasound methods. The device provides highly accurate measurements that are essential for calculating the correct IOL power to achieve optimal visual outcomes after cataract surgery. The IOL Master also helps identify patients who may benefit from premium IOL options, such as toric lenses for astigmatism correction or multifocal lenses for presbyopia correction.
What Is CPT Code 66984 Used For?
CPT code 66984 is used for extracapsular cataract extraction with insertion of a standard intraocular lens (IOL). This is the most common cataract surgery procedure, representing routine cataract removal with standard IOL implantation. This procedure involves removing the clouded natural lens of the eye while preserving the posterior lens capsule, then implanting a standard monofocal IOL to restore vision. The surgery is typically performed using phacoemulsification, where ultrasonic energy is used to break up the cataract for easier removal through a small incision. The standard IOL provides clear vision at one distance, usually for distance vision, with patients typically needing reading glasses for near vision. This code represents uncomplicated cataract surgery in patients without significant comorbidities or complex surgical requirements.
What Is CPT Code 66982 Used For?
CPT code 66982 is used for complex cataract extraction with intraocular lens insertion. This code is applied when cataract surgery involves additional complexity beyond routine procedures, requiring enhanced surgical techniques or addressing complicating factors. Complex cataract surgery may be necessary in cases involving dense or mature cataracts, small pupils, weak zonules, previous eye trauma, or other anatomical challenges that make the surgery more difficult than standard procedures. The surgeon may need to use specialized techniques, additional instruments, or devices such as pupil expansion rings or capsular tension rings to safely complete the procedure. Patients with conditions such as pseudoexfoliation syndrome, previous vitrectomy, or other ocular comorbidities may require complex cataract surgery. The procedure still involves IOL implantation but requires greater surgical skill and time due to the increased complexity.
What Is CPT Code 66987 Used For?
CPT code 66987 is used for cataract extraction with insertion of a drug-eluting intraocular lens. This relatively new procedure involves implanting an IOL that contains and slowly releases medication to help prevent certain post-surgical complications. The drug-eluting IOL contains anti-inflammatory medication that is gradually released over several weeks following surgery, potentially reducing the need for post-operative eye drops and minimizing inflammation-related complications. This technology represents an advancement in cataract surgery that may improve patient outcomes and compliance with post-operative care. The procedure involves the same surgical technique as standard cataract surgery but uses a specialized IOL designed to deliver medication directly to the eye over an extended period. This approach may be particularly beneficial for patients who have difficulty with post-operative medication regimens or are at higher risk for post-surgical inflammation.
What Is CPT Code 65855 Used For?
CPT code 65855 is used for laser trabeculoplasty, a minimally invasive laser treatment for glaucoma. This procedure uses laser energy to improve drainage of aqueous humor from the eye, thereby reducing intraocular pressure. Laser trabeculoplasty is typically performed as an outpatient procedure and serves as an intermediate treatment option between eye drops and more invasive glaucoma surgeries. The most common types include Selective Laser Trabeculoplasty (SLT) and Argon Laser Trabeculoplasty (ALT). The laser is applied to the trabecular meshwork, the eye’s natural drainage system, to improve aqueous outflow and lower eye pressure. This treatment can be effective for various types of glaucoma and may reduce the patient’s dependence on glaucoma medications. The procedure is relatively quick, typically taking 10-15 minutes, and can be repeated if necessary.
What Is CPT Code 67028 Used For?
CPT code 67028 is used for intravitreal injection, a procedure where medication is injected directly into the vitreous cavity of the eye. This treatment delivery method allows for high concentrations of medication to reach the retina while minimizing systemic side effects. Intravitreal injections are commonly used to treat various retinal conditions, including wet age-related macular degeneration, diabetic macular edema, retinal vein occlusions, and diabetic retinopathy. The medications most frequently injected include anti-VEGF agents (such as ranibizumab, bevacizumab, or aflibercept), corticosteroids, and other therapeutic agents. The procedure is performed in a sterile environment with local anesthesia, and patients typically receive a series of injections over time. The treatment has revolutionized the management of many retinal diseases and can help preserve or improve vision in conditions that were previously difficult to treat.
What Are CPT Codes 66170, 66174, and 66183 Used For?
CPT codes 66170, 66174, and 66183 represent different glaucoma surgical procedures used to lower intraocular pressure when medications and laser treatments are insufficient to control the disease. Code 66170 is used for trabeculectomy, a traditional glaucoma filtration surgery that creates a new drainage pathway for aqueous humor to leave the eye. This procedure involves creating a small flap in the sclera and removing a piece of trabecular meshwork to allow fluid to drain into a space under the conjunctiva. Code 66174 represents transluminal dilation of aqueous outflow canal, a newer minimally invasive procedure that uses microcatheters to open the eye’s natural drainage system. Code 66183 is used for insertion of anterior segment aqueous drainage device, which involves implanting a small tube or shunt to facilitate aqueous humor drainage. These procedures are typically reserved for patients with advanced glaucoma or those who have not responded adequately to less invasive treatments. Understanding these commonly used ophthalmology CPT codes is essential for healthcare providers, medical coders, and patients navigating eye care billing. Each code represents specific procedures and diagnostic tests that play crucial roles in comprehensive eye care, from routine examinations to complex surgical interventions. Proper coding ensures accurate billing, appropriate reimbursement, and clear communication between healthcare providers and insurance companies. As technology advances and new treatments emerge, the landscape of ophthalmology CPT codes continues to evolve, making ongoing education and updates essential for all stakeholders in eye care delivery.
Eye Care Billing Consultants
If your eye care practice is feeling overwhelmed with your medical billing, then reach out to Eye Care Billing Consultants (ECBC) today, and let us manage your practice’s billing, and let you focus on who matters most, your patients.
