Post

In a message dated 6/16/2005 10:23:56 A.M. Eastern Standard Time,
akunze@wenatcheeeyeear.com writes:

Because of CPT stating that a comprehensive code includes "Initiation of
diagnostic and treatment program."

Amanda

Well, a yearly exam would be your diagnostic program. Run with it!

Dr. Yaros

In a message dated 6/15/2005 5:16:04 P.M. Eastern Standard Time,
akunze@wenatcheeeyeear.com writes:

For a patient coming for a yearling diabetic exam where the doctor does a
complete exam what level of E&M do you think it would routinely qualify for?
I'm thinking only a 99213 due to decision making.

Thanks

Amanda

You are probably reimbursed more for 92014

Dr. Yaros

Our clinic has 2 general ophthalmologists and one glaucoma
sub-specialist (who, incidentally, is the one under coding). We also
have one optometrist. There is also something out there put out by
Corcoran Consulting Group that "cross-walks" e&m and eye codes. They
state that a 92014 is approximately equal to a 99214 in terms of the
complexity of the visit (of course there are differences in
documentation requirements). According to the statistics on the CMS
site, ophthalmologists have a fairly standard bell curve for e&m codes,
with the bulk being the 99213 and 99203, and the rest tapering off to
both sides. 1-2% of office visits submitted are at the 99205 and 99215
level, although our percentage of those codes is significantly lower
than that.
Shawn

We are general. And it sounds like what I originally thought was true. If we do a complete history, complete exam, but do nothing for the patient other than tell them to come back next year that the highest level we are going to be able to bill is 99213 or 99202.

Amanda

I stand corrected! Are you general ophthalmologists? The tidbit of info I shared was pertaining to general not sub-specialities.

"Gilman, Shawn M." wrote:-- Ophthalmology Coding Discussion Group
-- MsgId= 444671--
Around 14% of all visit codes submitted to Medicare by ophthalmologists
are 99214. 6% of our office visit claims (all carriers) are 99214 and
we have not had a problem. In fact, we just had someone in for an audit
and we were under coding, not over coding.

Shawn

Around 14% of all visit codes submitted to Medicare by ophthalmologists
are 99214. 6% of our office visit claims (all carriers) are 99214 and
we have not had a problem. In fact, we just had someone in for an audit
and we were under coding, not over coding.

Shawn

Be careful with 99214--it is very hard for an
ophthalmologist to meet the criteria according to an
AAO coding class I attended a while back. I have only
seen it used twice in my 15 years of doing this (and
both times, I dissected the chart & then sat down with
the doctor & made them go over the documentation again
before I even sent the claim!)

I just wish there was a way to reach 99214 and I can't find any way really that it would qualify.

I don't see that in the CPT book.

It actually states "with initiation OR CONTINUATION of diagnostic and
treatment program".

Some of these patients are young and have no rx to give them. The reason I'm wanting to know what level of E&M is because there are times that they do pay better than the intermediate codes. Plus if you read the info regarding intermediate codes it states "a new or existing condition complicated with a new diagnostic or management problem..." and sometimes these don't fall under that either.

Amanda

Because of CPT stating that a comprehensive code includes "Initiation of diagnostic and treatment program."

Amanda

We can't use an eye code so I'm trying to see what the highest E&M level would be. The impression is diabetes and the plan is to re-see the patient in 1 yr.

Amanda