The AOA’s Coding Experts offer guidance to support doctors and staff in providing the best possible patient care while ensuring accurate reimbursements are received.
Here are some recent questions posed to the experts and their answers.
When coding a 92002/92012 or a 92004/92014, I understand that I must have a new initiation of treatment. However, do I need a new diagnosis, too?
No, you do not need a new diagnosis code and you do not need a new condition in order to use the 92012 code.
Is dilation required to bill an office visit at a level 4?
Dilation is not required but often included. The CPT guidelines indicate that comprehensive ophthalmological services “often include, as indicated: biomicroscopy, examination with cycloplegia or mydriasis and tonometry. It always includes initiation of diagnostic and treatment programs.”
It also is critical to note that contractual agreements in vision plans that you may have signed may include a provision that you must dilate your patient as part of the exam. Please review and confirm your payer contracts.
I am a new graduate going through the Medicare enrollment process. I work at a few practices and would like to confirm whether I personally need a DMEPOS supplier number to prescribe glasses after cataract surgery.
Each practice would need to have a DMEPOS number for billing the materials. As the physician, you are providing the professional services.
Should CPT codes 92340, 92341 and 92342 be billed on all glasses dispensed, across all contracted insurances? Are you able to provide guidelines for using these codes?
When provided, fitting of spectacles is a separate service and is reported as indicated by 92340-92371.
Fitting includes measurement of anatomical facial characteristics, the writing of laboratory specifications and the final adjustment of the spectacles to the visual axes and anatomical topography. Presence of physician or other qualified health care professional is not required.
Supply of materials is a separate service component; it is not part of the service of fitting spectacles.
The use of the 92340-2 codes is really limited to some of the vision plans and CMS statutorily excludes coverage of glasses, except following cataract surgery. Learn more about the billing and coding guidelines.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.