An Eye on Coding

January 30th, 2010 - Nancy Maguire
Categories:   Coding   Evaluation & Management (E/M)  

An "Eye" on Coding

Ophthalmology coding is an interesting specialty, especially when it comes to assigning a level of evaluation and management code.  Coders outside this specialty may not realize that there are two sets of codes available to the eye specialist.  The first set is one we are all aware of, codes 99201-99215 for office encounters.  The second set is found in the Medicine section of the CPT® manual and includes codes 92002-92014.  These are termed "General Ophthalmological Services" or GOS codes.

The eye care provider (Ophthalmologist/Optometrist), has the option of using E/M codes or GOS codes as appropriate to medical record documentation.  The E/M series have key components (history, physical, and medical-decision-making), whereas the GOS codes are defined as Intermediate or Comprehensive new or established patient services.

This article will focus on the sometimes conflicting definitions and code descriptions for the GOS codes.  The GOS codes are preceded by "definitions" to define the content of these services.  The "Intermediate" service describes an evaluation and management of a new or existing condition complicated with a new diagnostic or management problem".  It includes history, general medical observation (not eye related, ex, diabetes), external ocular and adnexal examination and other diagnostic procedures as indicated.  The "Comprehensive" service describes a general evaluation of the complete visual system, may require more than one session.  This service includes history, general medical observation, external and ophthalmological examinations, gross visual fields, and basic sensorimotor examination.  It is a bundled service and includes as indicated: biomicroscopy, examination with cycloplegia or mydriasis and tonometry.  It always includes initiation of diagnostic and treatment plan.

If you follow this "definition" guideline for an Intermediate GOS code, 92002 or 92012, the patient must have a new problem or an existing problem with complications requiring management/diagnosis.  Using this logic a patient returning for a Glaucoma check and monitoring, in absence of complaints, will not meet the criteria for assigning a GOS intermediate code.  In this case the provider would assign the appropriate level of E/M code.  

Now if you read the code description listed with 92012 and 92014 you will note a conflict with the "definitions" note.  The established GOS codes state medical examination and evaluation, with initiation or continuation of diagnostic and treatment program.  Given the scenario where a Glaucoma patient is being monitored for pressure checks, the code descriptor does allow for a medical evaluation for continuation of a treatment program.  this variance has caused providers to make a decision on which descriptor they will follow, the note prior to the codes or the code definition itself.  Taking the conservative approach means the provider will need a new problem or a complication of an existing problem to code an established patient GOS code Intermediate level.
Payors have individual guidelines for the use of the GOS codes and their local policies should be reviewed.
Nancy Maguire


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association