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32 Cards in this Set

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codes for All levels of encounters/exams •
• Ophthalmic materials, supplies (HCPCS codes)
CPT exam
codes)represent specific
exam descriptions, procedures, surgery
codes for Procedures in addition to the exam
(CPT
procedure codes)represent specific
exam descriptions, procedures, surgery
codes for Diagnoses/diseases
(ICD-9 codes)
What does CPT stand for
CPT= Current Procedural Terminology
Two options for CPT codes (what #S do the codes begin w/?)
92--- codes and 99--- codes
what cpt codes are the opthalmology codes?
92 codes
can the 92 codes also be used to bill for a medical exam
yes (and a visual exam)
how many times a year can you bill a 92 code for vision
1
a 92 code intermediate exam must include how many exam elements (which much include 2 specific things)
at least 7 exam
elements
• Must include lids and adnexa
a 92 code comprehensive exam must include how many exam elements (which much include 2 specific things)
need at least 8 exam
elements
• Must include EOM and CF
T or F: you can bill a 92 code comprehensive exam for maintaining same therapy as
last year
False: Must be initiating or changing therapy of some
kind
What CPT codes are for evaluation and management
99--- codes. Codes for
exams/procedures involving all parts of
the body
how many options/levels are there for 99 codes?
10
Whats they big deal about medicare and guidelines?
Medicare guidelines are the standard by
which all other insurance providers follow
Key Elements in determining level of
service/exam:
1. History
• 2. Examination (its content)
• 3. Medical-Decision Making
as a group, what determines
determine the level of HISTORY in the
medical record
The CC, HPI, ROS and PFSH
New Patient
requires what 3 key components
History ,Exam, Decision
Making
Established patient
requires at least how many of the key components (History, exam, decision making)
2of 3
ICD 9 codes are for what?
Diagnosis - code must support the need for
test
Can NOT bill ______ and ______ on same day
(at UABSO)
GDx ,visual field
Pachymetry for CCT can be billed (how many times?) in a person's life;while gonioscopy can be billed ______ in a year
once , once
should you bill for a surgical code along with an exam code?
no. bill for procedure today. rtc in 2 wks for exam, and then bill for exam.
how long is the global period for procedures: can not bill for any additional visits
within that period
10 days
if, during a global period, you do another procedure that is totally unrelated to the first one (on the same patient) can you bill for it?
Need for unrelated visit/exam: must use modifier
code to indicate that
what codes are surgical codes/
6-----
for vision insurance, use these codes
92
if your 19 yo patient had a refraction of +.25-.25 x 180 and the patients vision plan does not cover refraction,do you still charge the patient for a refraction?
No, When billing separate for refraction: only
bill for a prescribable Rx
what are "consultation codes"
Office - a doctor seeking opinion of another doctor, not a referral AND Confirmation: a
patient seeking a 2nd opinion
(Must be initiated by patient)
Is Systemic hypertension w/o retinopathy a medical diagnosis?
NOT a medical diagnosis
can Systemic diabetes w/o retinopathy be billed as a medical diagnosis?
Yes, it can be billed as a medical diagnosis every year
V58.69 is a CPT code for when...
patient is taking a medication that
has ocular side-effects
V72.0 is a CPT code for
emmetropia