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When it comes to ophthalmology medical coding, physicians are faced with some general confusion on the application of codes. The question is whether to apply ophthalmologic service codes (92002-92014) or evaluation and management (E/M) codes (99201-99215) for the office visits of new or established patients. Well, here are some indicators that can help you make proper decision.

Ophthalmology service codes are meant for eye examination. If an eye function is evaluated, then the service code should be applied. Even though service code 92002-92014 covers most of evaluations and situations, they are not exhaustive. Also, history documentation requirements for eye codes are less cumbersome compared to those for E/M services.

So then, what are E/M codes and when they should be used? Any treatment or services that don’t fit within the guidelines of eye codes are subject to E/M codes. Higher E/M codes represent complex or difficult cases whereas lower E/M codes are used for examinations and follow-up visits for minor problems.

Both E/M and eye exam codes have the same set of rules for determining patient status and clearly distinguish between new and established patients. In the case of a physician in a group practice billing under the same group number, an established patient is one who has been provided with a face-to-face service by within the past 36 months.

Though these points are effective guiding principles when it comes to billing, it is the individual payers who dictate the rule for reporting ophthalmologic service codes and evaluation and management codes. Professional medical billing and coding companies have a team of coding specialists who can provide accurate medical coding services in keeping with coding rules and payer guidelines and specifications.