Optometry Coding & Billing Alert

Exam Coding: Expand Your Coding Options For Patients Refusing Dilation


- Published on Tue, Dec 07, 2010

Tip: You can schedule a second office visit -- but beware this coding stipulation.

You know the routine: A patient shows up for an exam, but he won't let the optometrist dilate his pupils that day. Whatever the reason -- time, the drive home, etc. -- you're stuck trying to find the best way to report a dilation at a separate visit.

Most Medicare carriers assume that a dilated fundus exam will be a part of any comprehensive eye exam you perform and bill with 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits) or 92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits), says Raequell Duran, CPC, president of Practice Solutions, a coding, compliance, and reimbursement consulting firm in Santa Barbara, Calif. Without dilation, you cannot perform the [...]

Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*