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Billing and Coding Information

Effective from 1/1/2020

CPT 92201 will replace 92225

CPT 92202 will replace 92225

92201= with retinal drawing and scleral depression

92202 = with drawing of optic nerve or macula

92201 & 92202 are bilateral codes

Cataract Fees – 15% drop in physician reimbursement (AAO.org)

For Cataract Surgery, Medicare patients pay average $195 if done in ASC (Medicare.gov)

For Cataract Surgery, Medicare patients pay average $383 if done in Hospital Outpatient (Medicare.gov)

Keeping You In The Know

The field of Billing and Coding has constant changes, news, and updates. At MBS, we work through the insurance maze and keep you updated on all the news.

National Medicare Average for Evaluation and Management (E&M) Code Use for Ophthalmology

New Patient Code

99201 – 0.20%

99202 – 2.60%

99203 – 19.30%

99204 – 73.40%

99205 – 4.40%

Established Patient Code

99211 – 0.70%

99212 – 10.40%

99213 – 51.40%

99214 – 34.60%

99215 – 2.90%

The Ophthalmology
Advantage

New Patient Code

99202
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient

99204
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits

Established Patient Code

99212
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient

99214
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits

Evaluation and Management Code Changes in 2021

Major changes are coming in E/M coding starting 2021. From 1/1/2021, 99201 will be deleted. Determination factors of levels of E/M code will drastically change as well. Guidelines for choosing the level of code will be more sensible and easy to follow. E/M codes will be chosen based on level of Medical Decision Making or Total Time Spent. Providers will no longer have to count different elements of the exam. This will reduce errors in up-coding or down-coding. Best news of all, fees for E/M codes will greatly increase, according to CMS.

 

E/M codes, starting January 1, 2021

New Patient Codes                                         Established Patient Codes

99202                                                             99212

99203                                                             99213

99204                                                             99214

99205                                                             99215

If You Have Any Questions