• Low Vision Exams


    We hired a new provider to do low vision exams. They often charge a level 5 E/M due to the amount of time spent with the patient. We are concerned because we rarely use this level for exams in our office. Is this appropriate for low vision exams?

    Answer: If the physician performs an examination consistent with the requirements for a level 5 E/M code, including physician time with the patient on the date of service, then it is appropriate. Document the time for the appropriate activities that does not include any testing with a CPT code or is separately billable. 

    A few reminders about what qualifies as physician time when billing and E/M code for outpatient visits:
    • Preparing to see the patient, such as reviewing tests
    • Performing a medically necessary appropriate examination and/or evaluation
    • Obtaining and/or reviewing separately obtained history
    • Counseling and educating the patient, family, or caregiver
    • Ordering medications, tests or procedures
    • Documenting clinical information in the EHR or other health record
    • Referring/communicating with other health care providers when not reported separately
    • Care coordination when not reported separately
    Frequently coding E/M level 5 could prompt focused medical reviews from insurance payers.
    If the physician is performing any vision rehabilitation services, consider billing the vision rehabilitation CPT codes (97533-97537) as appropriate