1. Carolyn Carroll
   Posted 4 months ago #
   

   Does the provider need to document a "review of systems" when billing the ophthomology codes 92002, 92004, 92012 and 92014?

2. SuperCoder
   Posted 4 months ago #
   

   NO NEED OF ROS. The mode of evaluation for 92002-92014 are entirely different from E/M Coding 99201-99215 level codes. I took this as opportunity to detail the guidelines in the posting below.

3. SuperCoder
   Posted 4 months ago #
   

   There are specific documentation requirements for using E&M codes AND 92xxx Eye Exam and Treatment codes
   *
   They are not the same.
   *
   The requirements are more specific and stringent for E&M codes.
   *
   While the documentation requirements for E&M codes will satisfy the requirements for 92xxx Eye exam and Treatment codes – the reverse is NOT true.
   *
   COMPREHENSIVE EXAM
   ==================
   National Mandatory Components:-
   History
   General Medical Observation
   External Examination
   Gross Visual Fields
   Basic sensorimotor Evaluation.
   Ophthalmoscopic Examination.
   *
   Optional Components:-
   Biomicroscopy.
   Examination with Cycloplegia.
   Tonometry.
   *
   Miscellaneous Components:-
   Initiation of diagnostic and treatment programs.
   *
   *
   Intermediate Exam
   ==================
   National Mandatory Components:-
   History.
   General Medical Observation.
   External ocular and adnexal examination.
   Other diagnostic procedures as indicated.
   *
   Optional Components:-
   May include mydriasis for for ophthalmoscopy.
   *
   *
   There are 13 exam elements that must be documented to validate a coding level:-
   ------------------------------------------------------------------------------
   Testing visual acuity
   Gross visual fields
   Ocular motility
   Pupils
   Iris
   Eyelids and adnexae
   Conjunctiva
   Cornea
   Anterior chamber
   Lens
   Intra-ocular pressure
   Retina
   Optic disc

   *
   Note that some procedures are bundled:–
   --------------------------------------
   Included as part of - the 92 series exam codes.  This means you would NOT put a separate CPT code for these procedures if done as part of your exam using a 92 series exam code.  The bundled procedures are:-
   Amsler grid
   Brightness acuity test (BAT)
   Corneal sensation
   Exophthalmometry
   General medical observation
   Glare test
   History
   Keratometry
   Laser interferometry
   Pachometry
   Potential acuity meter (PAM)
   Schirmer test
   Slit lamp tear film evaluation and transillumination
   *
   *
   FINAL EXAM LEVEL CODING GUIDELINES FOR EYE:-
   If nine or more exam elements are documented = a comprehensive exam (92014 or 92004)
   If three to eight of the exam elements are documented = an intermediate exam (92012 or 92002)
   If less than three of these elements are documented Use the lowest level E&M code Level based on the provider’s documentation (99201-new pt or 99212-99213 - est. pt)

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