How to Code Ophthalmologic Services Accurately

June 6th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   CPT® Coding   Ophthalmology   Optometry   Billing   Documentation Guidelines  
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Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.

Quick Correct Code Selections List

According to Article A19881 which was published in 2004 and retired in 2012, Medicare identified the key documentation points for the codes identified in the following table. Even though the article is now retired, the information contained within this article is still valid for the dates of service for which it was active and can continue to identify key documentation points for these services going forward sincea new LCD hasn’t replaced the retired article.

Ophthalmological Services

New Patient

Established Patient

92002 Intermediate exam

92012 Intermediate exam

92004 Comprehensive exam

92014 Comprehensive exam

Count the Elements to Determine the Correct Code

The Article identifies 11 physical examination elements for an ophthalmologic examination, which include:

  1. Test visual acuity (doesn’t include refraction)
  2. Confrontation visual fields
  3. Eyelids and adnexa
  4. Ocular motility
  5. Pupils/iris
  6. Slit lamp examination required for these elements
    • Cornea
    • Conjunctiva
    • Anterior Chamber
    • Lens
  1. Intraocular pressure
  2. Ophthalmoscopic exam
  3. Post segment retina
  4. Vitreous
  5. Optic nerve

How Many Elements per Code?

The Benefits of Using Cheat Sheets Based on Payer Policies

The benefits of using payer information (e.g., LCDs) to identify key elements of documentation are incredible. Medicare tends to be the primary researcher for most guidelines pertaining to medical necessity and documentation and many payers follow their lead. This means your Medicare Administrative Contractor may have provided documentation guidelines for the codes you frequently report and will tell you what they expect to find when they request a copy of the medical record for review. Using policy-driven cheat sheets removes the guesswork and makes it easy to establish documentation guidelines for the codes your organization reports most often.

Find Payer Guidance Quickly Using Find-A-Code

Find-A-Code links guidance directly to the code being reported. Simply search any code and click on Medicare or Commercial Payer Policies to quickly locate payer policies containing key information that must be included in the documentation.

For a low monthly subscription fee, Find-A-Code helps you work with accuracy and efficiency. To request a free 14-day trial, go to https://www.findacode.com/account/request-trial.php and submit your request today.

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Questions, comments?

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