Most ophthalmic practices use a combination of eye visit and evaluation and management (E/M) codes in their billing. Although they’ve been around for a while, many are still confused about when to use one type of code over another.
All physicians use E/M codes in their practices, but eye visit codes are used exclusively by ophthalmologists and other eye specialists. Eye visit codes are more straightforward and can apply to a variety of medical situations, but they can vary from payer to payer. E/M codes are often used for more serious conditions and systemic diseases. Both types of codes can apply to new and established patients. Both can be used for an office visit. But there are subtle differences.
Choosing one type of code over another is an essential skill for a young ophthalmologist, particularly those in private practice. The wrong code choice could translate into lost revenue for the practice, the denial of a claim or, in a worst-case scenario, an audit and paybacks. We’ve compiled a list of resources to help you fill in the gaps and be aware about how proper coding can impact your practice.
Knowing as much as you can about these types of codes will help you stay on solid ground and make your claims defensible in an audit.
How to Choose Between E&M or Eye Codes
Knowing who your top payers are can help your practice determine if E/M or eye visit codes are more appropriate. Why should you choose an E/M code over an eye code? Commercial payers may have higher allowable reimbursements for E/M codes. Check out this article for other examples.
Eye or E&M Code? That Is the Question
Choosing the right type of exam code can be tricky. Learn the commonalities and differences between the two sets of codes and situations where it’s best to use one type of code over another.
12 Vital Elements in Choosing a Code
A comprehensive exam involves more than just a few exam elements. What 12 elements are required in determining whether to use one code over another? Intraocular pressure and visual acuity are only two of them. Find out the rest in this quick review of what applies to both E/M and eye visit codes.
What’s New for 2019
Changes went into effect earlier this bill that alter the kind of records you need to bill. Find out what they were and how they may impact your practice.
Build Coding Courses Into Your Education
Want even more information? Consider attending a course offered at AAO 2019 called E/M vs. Eye Codes: Who Is the Winner? It’s scheduled for 4:30 to 5:30 p.m. Monday, Oct. 14 at the Moscone Center during the Academy’s annual meeting in San Francisco.
Instructors Matthew M. Baugh, COT, MHA, OCS, OCSR, OSC, and Joy Woodke, COE, OCS, OCSR, will show participants how to distinguish between medical and vision and wellness exam documentation, apply Medicare and non-Medicare payer documentation rules and recognize the importance of the exam and patient expectations.