Below is the narrative description for the intermediate eye codes:. Intermediate ophthalmological services 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.
The narrative description for the comprehensive eye codes contains the following excerpted information:. Comprehensive ophthalmological services describes 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 ophthalmoscopic examination, 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. Intermediate and comprehensive ophthalmological services constitute integrated services in which Medical Decision Making cannot be separated from the examining techniques used.
Itemization of service components, such as slit lamp examination, keratometry, routine ophthalmoscopy, retinoscopy, tonometry, or motor evaluation is not applicable. Initiation of diagnostic and treatment program includes the prescription of medication, and arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services. Special ophthalmological services 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 may be reported in addition to the general ophthalmological services or evaluation and management services. Did you skim over the definitions above?
Please read them again carefully. Your successful defense, if and when audited, will depend on your understanding of these requirements and having supported them with the proper chart documentation. Let us take a closer look. Not true. Medical necessity is the crux of the Medicare reimbursement program. The service itself—and the component parts of each code—must be medically necessary.
Performing a service because it is good medicine does not make it medically necessary, according to Medicare. There are three main components of an office visit: 1 history, 2 examination, and 3 medical decision-making. Table 1 provides a breakdown of the mandatory and optional components of intermediate and comprehensive eye codes.
One problem with eye codes that must be dealt with involves the differences between the prefatory statements and the code descriptors. It may be more problematic to fulfill this requirement in established patients because the key word is initiate , which does not suggest simply having a patient return in 6 months.
Those are codes to and to Among the important changes for this xx exam code series is that using the history and the exam for the purposes of choosing a code are minimized, although they will remain important to documenting the reason for visits and for liability protection.
Additionally, if you use inpatient hospital exam codes, those are staying the same for , although they are slated for significant changes in or later. Q: What is happening to the Medicare payments for eye exams in ?
A: For medical visits, the proposed rule shows large changes in what doctors will be paid next year. We should see the Final Rule and payment announcement around the first of December. Here are the current payment amounts for and the proposed changes for National Medicare rates :.
Q: That sort of decrease sounds awful. What alternatives are there? A: Some important things to remember are that the average eye practice sees about 80 percent established patients, and only 20 percent are new patients. Q: What about the Eye exam codes? If I still get better payment on the Eye code, are the rules for using them changing? Q: I heard the level 1 exam codes are being deleted. You can still use it in the limited circumstances where it still fits.
You should upgrade or use an alternative browser. Thread starter pegjoh Start date Nov 21, I have a patient that came in as a new patient the provider performed a comprehensive exam and prescribes them glasses. What level of service would you recommend? They should also be establishing a care relationship. If it was a basic healthy exam with no follow up reasons, I would recommend x2 but an argument could be made for x4 if both VF and muscles were checked.
Cheezum51 Expert. Messages Best answers 0. Also, if a refraction was done, remember to bill the and charge the patient for that service, which they would most likely pay out of pocket because very few medical plans pay for that code. Tom Cheezum, O.
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