Billing binocular vision evaluation...

[Uilleann]

For any of the billing guru's here: We have a pediatric doc who comes in a couple days each month to work on the tiny humans in our practice. But she doesn't seem to code each of her binoc eval visits consistently. Wondering for those of you with a similar doc or who offer this type of service, what code do you find appropriate for the visit itself? We're assuming a 99 (as opposed to a 92 as it *seems* medically indicated), but of course the diagnosis will have to consistently reflect that. Is there some other code we should be aware of perhaps? A 6 code maybe?

Cheers!

Bri~

[drk]

Depends on the purpose of the visit.

If it's considered "routine" (and that's a whole discussion right there), then she would use the routine exam codes. If there is a medically necessary reason, then the E/M or ophthalmological codes.

For the "sensorimotor exam" there is a special diagnostic procedure code (if the sensorimotor exam definition fits the service), and it reimburses about $40. If it's a routine case, then the patient pays out of pocket. If it's medically necessary, you'd need a pretty good diagnosis code to get it to work. http://www.aapos.org/client_data/fil...approved04.pdf

[Uilleann]

Depends on the purpose of the visit.

If it's considered "routine" (and that's a whole discussion right there), then she would use the routine exam codes. If there is a medically necessary reason, then the E/M or ophthalmological codes.

For the "sensorimotor exam" there is a special diagnostic procedure code (if the sensorimotor exam definition fits the service), and it reimburses about $40. If it's a routine case, then the patient pays out of pocket. If it's medically necessary, you'd need a pretty good diagnosis code to get it to work. http://www.aapos.org/client_data/fil...approved04.pdf

Cool. Thanks Doc. Generally speaking, these visits are post-routine visit, and are often suggested consults from our two other ODs. (Not referrals per se if I remember the correct terminology, as we're not completely transferring care to her...and it's the same office location.) My thought was that it should probably be a 99 visit, with the appropriate ICD attached to justify the medical billing. Just trying to be as consistent and 'audit-proof' as possible here.

Appreciate the feedback!

Bri~