• Frequency Edits for Examinations


    Are there frequency edits for subsequent visits? Example: The patient has a corneal ulcer and comes back two days from the initial visit, and then three additional visits over a two-week period.

    Answer:

    There are no frequency edits for E/M or Eye visit codes by Medicare payers. Office visits can be billed based on medical necessity. Commercial payers may have frequency edits for Eye visit codes. Verify this along with patient eligibility. Code the appropriate E/M f or Eye visit code based on their unique documentation requirements. For additional information about billing these two options, review How to Choose Between E/M and Eye Visit Codes.