Correct answer: A. 99203
AAO 2019 attendees: 38% answered correctly.
For new patients utilizing E/M audit tool, you need three out of three components. Since the question indicated a detailed exam, the level of service is 99203. Had it been a comprehensive exam, which is 12 exam elements plus mood and affect, 99204 would be correct.
Correct answer: B. 99204
AAO 2019 attendees: 29.5% answered correctly.
When tests are performed before the ordering physician sees the patient and determines what is medically necessary, it means either the practice will absorb the cost or the patient will be responsible and should be notified and agree to the fees prior to performing services. Even if pathology is found, the test is still not billed to the payer. Separating out the technical component alone (-TC) would still require an order on file, which is why that answer is incorrect. Typically -TC is billed when an outside physician who does not own equipment wants the test performed while they plan to provide the interpretation.
Use caution because billing for tests days before seeing the patient for the first time is a Recovery Audit (RAC) trigger. Remember, equipment does time and date stamp when services are performed.
Correct answer: A. Never
AAO 2019 attendees: 44% answered correctly.
Eye visit codes 92002, 92004, 92012 and 92014 were published pre-1983, whereas the Evaluation and Management (E/M) specialty specific guideline for ophthalmology was 1997.
Eye visit codes include a general medical observation and history, neither of which offer additional requirements. These codes also include exam elements and initiation or continuation of diagnostic or treatment program.
The E/M codes have three components (history, exam and medical decision making) each with an assigned point system. Once calculated, the level of service is determined.
C. Locum tenens doesn’t applyAAO 2019 attendees:
56% answered correctly.
It only applies when a physician of the practice is away for no more than 60 days. If the physician will be gone longer or is leaving the practice, you may need to credential another physician to see patients in the practice. Locum tenens is not an option when a new physician is hired but not yet credentialed with a certain payer. In these circumstances, the practice may absorb the fee or the patient, if known ahead of time and agreed upon, will be responsible.
A. Retina submits an established patient exam
AAO 2019 attendees:
39.6% answered correctly.
Although ophthalmic specialty societies now have their unique taxonomy codes, they are all a subset of the main ophthalmology taxonomy code. When in a multispecialty practice, internal referrals would be considered as established patients. Find more information at aao.org/taxonomy.