Medical Coding Training — Ophthalmology Coding


Okay, this one is from Thomas. “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, 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. Okay so here it is in my CPT book. So ophthalmological services, that’s basically
your eye codes. Medical 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 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. Get more cpc exam tips, coding certification
training and ceu credits. Go to www.codingcertification.org

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