The general ophthalmological services, or “eye codes” as they are often referred to, consist of 92002, 92012, 92004, and 92014. They are appealing to many due to the simplicity of their requirements.
Comprehensive Ophthalmological Service (92004 – new patient, 92014 – established patient)
- Case History
- General Medical Observation
- Basic Sensorimotor Examination
- Gross Visual Field Testing
- External Examination
- Ophthalmoscopic Examination (with or without dilation)
- Initiation or Continuation of a Diagnostic and Treatment Program
Intermediate Ophthalmological Service (92002 – new patient, 92012 – established patient)
- Case History
- General Medical Observation
- External Examination
- Other Diagnostic Procedures, as indicated
- Initiation or Continuation of a Diagnostic and Treatment Program
- New Problem or Complication
Any encounter that satisfies the bulleted requirements notes above qualifies for that associated code. This means: Any reason for visit that necessitates the performance of all seven of the “comprehensive” exam requirements qualifies for either 92004 or 92014. Similarly, an encounter coded at the comprehensive or intermediate level that has not satisfied the corresponding requirements has been coded improperly.
Of critical importance is the intermediate codes require a “new problem” or “complication” of an existing problem to be viable. A three-month IOP evaluation for POAG, for example, where all is well-controlled, no changes are made to treatment, and there are no new complaints/problems addressed would not qualify. And since all of the requirements for the comprehensive code would be unlikely to be met through this type of visit, the provider would need to use the 99xxx series codes to correctly code the visit.
Historical, chart review data shows about 80% of all encounters to qualify for one of these 92xxx series codes. while 99.9% of encounters qualify for one from the 99xxx series. Thus, it is important to understand both code series and not commit to using only one code.