• Billing exam with visual fields

    A patient is a glaucoma suspect and has bilateral nuclear cataracts. The visual fields ordered and performed today are stable. Should this be billed at 99214 because there are two stable chronic diseases, and a visual field was ordered, and the results interpreted?

    The exam should be coded as level 3 with either 99203 or 99213 or, if the exam is not impacted by one of the nine indications when an Eye visit code can’t be billed, then with the appropriate level of Eye visit code. . 

    Both codes require medically appropriate history and/or exams and a low level of medical decision making as shown on the chart below. (See also Nine Scenarios When You Should Not Use an Eye Visit Code, EyeNet Magazine, Sept. 2019)

    Component Criteria Level
    Number and/or complexity of problems: Two or more stable chronic illnesses Moderate

    Amount and Complexity of Data

    N/A. Tests with a CPT code for which the practice has or will be ordering do not count in the amount and or complexity of data as you are paid separately for the tests.

    Risk of complications and/or morbidity: