Procedural Coding
Decision making can be broken down into what three areas?
1. # of diagnoses or management options considered 2. Amount/complexity of diagnostic tests, other info 3. overall risk
History can be broken down into what three areas?
1. HPI 2. ROS 3. PFSH
99XXX can be broken down into what three areas?
History Examination Decision making
Describes an evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis, including history, general medical observation, external ocular and adnexal examination and other diagnostic procedures as indicated; may include the use of mydriasis for ophthalmoscopy.
Intermediate Ophthalmological Services
Established patient
One who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years
92012
Ophthalmological services; medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, ESTABLISHED patient
92002
Ophthalmological services; medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, NEW patient
92015
Refraction
Describes services in which a special evaluation of part of the visual system is made, which goes beyond the services included under general ophthalmological services, or in which special treatment is given
Special Ophthalmological Services
Adjunctive Ophthalmology Codes can be broken up how?
Technical component Professional component Both
368.40
VF defect
What do CPT codes do?
used to report the work that you perform during a basic exam
Special Ophthalmological Services (what are the numbers?)
92XXX
Three subsets of CPT codes
Adjunctive Ophthalmology Codes Evaluation and Management Codes S-codes
CPT is owned and administered by whom?
American Medical Association (AMA)
365.01
Glaucoma suspect
A general evaluation of the complete visual system. The comprehensive services constitute a single service entity but need not be performed at one session. The service includes history, general medical observation, external and ophthamoscopic examinations, gross visual fields and basic sensorimotor examination. It often includes, as indicated: biomicroscopy, examination with cycloplegia or mydriasis and tonometry. It always includes initiation of diagnostic and treatment programs; i.e. prescription medication, arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services.
Comprehensive Ophthalmological Services
92014
Comprehensive, established patient, one or more visits
92004
Comprehensive, new patient, one or more visits
CPT (what does it stand for)
Current Procedural Terminology
What are E/M codes used for?
Describe any medical exam, including eye exams
92070
Fitting of contact lens for treatment of disease
92083
Full threshold visual field
367.20
astigmatism
918.1
corneal abrasion
What are Adjunctive Ophthalmology Codes used for?
describe eye exams ancillary services beyond a basic eye exam
365.11
glaucoma
92018
gonioscopy
367.1
myopia
New patient
one who has not received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years
367.4
presbyopia
