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Deaconess Posted Fri 11th of August, 2017 12:06:25 PM
Hi, I was hoping someone could clear something up for us. In order to bill a comprehensive eye exam, 92004 or 92014, it requires the initiation of diagnostic or treatment program. Part of this says "arranging for special ophthalmological diagnostic or treatment services". So if the physician, at the end of his note, states he is going to see the patient in 6 months and do an OCT at this time, does this count towards the "arranging of diagnostic tests"? or does it have to be done at the same appointment? And what if they are continuing a medication, but not starting a new one or changing anything, does this count towards continuation of a diagnostic treatment program?
SuperCoder Answered Tue 15th of August, 2017 23:48:54 PM

Hi Deaconess,

Comprehensive visit always includes initiation of diagnostic and treatment programs. However, in the above scenario there was continuation of same medication/treatment which will come under intermediate, established patient. Moreover, some private payers may only pay for the 92004 or 92014 codes once per year because they consider these codes to be annual eye exam. Please feel free to ask for any further query. Thank you.



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