Billing and Coding Information
Effective from 1/1/2020
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
