Ophthalmology CPT Codes for 2023

Ophthalmology CPT Codes for 2023
Dr Josh November 16, 2022 medical billing

Ophthalmology CPT codes provide reimbursement for specific procedures that an ophthalmologist may perform. Ophthalmologists are doctors who specialize in eye care, focusing on diagnosing, treating, and preventing conditions of the eyes and visual system.

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Ophthalmology CPT codes are used to report the medical billing services provided by ophthalmologists. The codes are available in the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) manual and are updated annually. In 2022, some new ophthalmology billing and coding will be added, along with updates and revisions to all existing ones.

Ophthalmology CPT Codes Deleted in 2023

Here are a few changes implemented in 2023:

  • Ophthalmological examinations are broken down into components using CPT codes 92002–92014. These codes reflect general ophthalmological services. These general revision dates (Medicare) are included in the E&M code report whenever it is submitted. 

It is unnecessary to submit ophthalmological service codes individually (for example, CPT codes 92002–92014). Ophthalmological services of a generic kind are included in the E&M service.

  • In the field of ophthalmology, the term “special ophthalmological services” refers to specialized procedures that are not part of a standard or general eye checkup. Specialized ophthalmological services can be reported on in their own right since they are considered significant and identifiable.
  • The insertion of an IV catheter and the injection of dye are both necessary parts of operations that require the intravenous administration of dye or another diagnostic agent. 

Nonetheless, these two steps are not individually reportable since they are fundamental components of the process. As a result, the CPT codes 36000 (insertion of a syringe or catheter), 36410 (venipuncture), 96360-96368 (IV infusion), 96374-96376 (IV push injection), and selective vascular catheterization codes are not reportable independently in conjunction with services that require intravenous injection (e.g., CPT codes 92230, 92235, 92240, 92242, and 92287).

  • Angiographies can be performed using selective catheterization and injection techniques, which are covered by CPT codes 92230 and 92235 (fluorescein angioscopy and angiography).
  • Fundus photography (CPT code 92250) and scanning ophthalmic computerized diagnostic imaging (codes 92133, 92134) are often mutually exclusive since a provider or supplier will utilize one technique or the other to evaluate fundal illness.

On the ipsilateral eye, however, there are only a select few clinical circumstances in which both procedures are appropriate and required from a healthcare perspective. When dealing with such circumstances, it is possible to report any of these CPT codes by applying the appropriate modifier to CPT code 92250.

  • When done during the operative process or post-operatively on the same day of service, prolonged ophthalmoscopy (CPT codes 92201, 92202) is a part of posterior segment ophthalmic surgical operations (CPT codes 67005–67229). 

Extended ophthalmoscopy is typically not performed preoperatively within the same treatment date, except in emergencies. (The 92225 and 92226 CPT codes were eliminated on January 1, 2020.)

  • It is not permitted to submit CPT code 92071 (Contact lens fitting for the management of ocular surface disease) together with a corneal operation. 

Ophthalmology CPT Code 68312

A telephone or e-mail visit is a visit during which the health care provider (HCP) speaks with the patient or family by telephone or e-mail. This visit aims to assess and evaluate the patient’s condition, make treatment recommendations, and/or provide medical advice. This does not include an initial evaluation of a newly established patient relationship.

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This code differs from 69211 because it allows for communication between HCPs and patients over phone or through Internet chat rooms where both parties are not physically present together in one place simultaneously.

Ophthalmology CPT Codes 99201-99215

99201-99215 are New Patient (99201-99205) and Established Patient (99211-99215) office/outpatient visits. These codes are for an initial visit to an ophthalmologist or optometrist for a patient who has never seen the physician before. If this person is already a patient of the doctor, then it would be classified as established patient visit codes 99201-99215.

The other reason for the difference in codes is that a new patient visit may be coded as an established one. For example, if an individual comes in to see their optometrist and leaves with a prescription for glasses, it would be coded as an established patient visit. The same goes for when someone comes in for their first eye exam and leaves with glasses because they can’t wear contacts anymore (this change would also be noted on their chart).

Ophthalmology CPT Codes 99217-99220

These codes may be reported in addition to an office visit code. They are only relevant for patients admitted to the hospital through the emergency department. They do not apply to those with appointments for elective admission or patients admitted from the outpatient department.

Ophthalmology CPT Codes 99221-99223

These codes are only relevant for patients admitted to the hospital through the emergency department. They are not used for patients with appointments for elective admission or patients admitted from the outpatient department.

You should use 99221-99223 if you’re admitting a patient to your hospital from an emergency department and need to report any additional services provided during their stay. This includes those already reported under another code (for example, endoscopy).

Ophthalmology CPT Codes 99241-99245

The consultation may be billed as a separate service when a physician consults another physician. When this occurs, you will need to use one of the following codes: 99241-99245.

These codes indicate a consultation at the request of another physician or other source. However, they are only needed when a separate report is prepared for that requesting party. If no separate report is prepared, use an E&M code instead.

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When a consultation involves multiple physicians, the billing code should reflect this. For example, if two physicians consult on a patient, use 99214 rather than 99241. In addition to these codes, there are separate codes for consultations in an emergency room setting (99236-99237) and psychiatric services (99275).

Ophthalmology CPT Codes 99301-9930

CPT code 99304 covers the initial observation care, observation discharge day management, and each additional hour of observation care after the initial hour (see also 99303). Note that since these codes are intended for observation services in conjunction with outpatient hospital visits, they should not be used during ED visits or if the patient was admitted to the hospital directly from the physician’s office via an outpatient order.

For example, you might use this code when a patient is discharged from their appointment but has to return because of their condition.

Conclusion

Ophthalmology CPT codes are used to identify procedures performed by ophthalmologists. Ophthalmologists are doctors who specialize in the medical and surgical care of the eye. With SmartClinix, you can benefit from the most accurate ophthalmology medical billing services. Visit SmartClinix now and get your appointment today!

Dr Josh

Dr. Josh is a physician who's helping spread the knowledge about Telehealth and its advantages. At SmartClinix, he's providing his expertise and knowledge in the form of engaging articles on various health & tech related topics.

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