MedicineH
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Feb 20, 2024
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Uploaded by ConstableGiraffe3016
A patient who suffers from keratoconus goes to her ophthalmologist's office
for a contact lens fitting. How would this visit be billed?
Correct answer: 92072
In the index of the CPT book, you will look up contact lens services, fittings, and prescription. This gives us two code ranges: 92071-92072 and 92310-92317. The main difference between the two code ranges is what the lens fitting is actually for. In the case of this question, the patient has keratoconus. Code 92072 is for the fitting of a contact lens for the treatment of keratoconus, initial fitting. Since this is exactly what the question asks for, this would be the correct answer to the question.
Code 92071 is also for the fitting of contact lenses, but it is for the treatment of ocular surface disease. Since this is not what the question asks for, this would be an incorrect answer. Code 92136 is for ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation. This is not what the question asks for at all, so this would be incorrect. Code 92100 is for serial tonometry with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day. This is also not what the question asks for, so this
is incorrect.
Reference:
AMA CPT® 2023 Professional Edition. Pg 743.
A patient comes into her eye doctor's office on an emergency basis. She is having pain in the eye she had surgery on about two weeks ago. After the patient has diagnostic imaging of the optic nerve in both eyes, the doctor determines that there are no new changes in the eye and the pain is physiological. He has the patient come back in one month for a regular postoperative follow-up. This emergency visit was approved by the doctor and regularly scheduled patients were bumped to a later time in order to accommodate the patient.
How would this be billed?
Correct answer: 99024, 92133, 99058
For this question, you will need three codes: one for the postoperative visit, one for the optic nerve imaging, and one for the emergent walk-in visit type. First, you will go to the index in the CPT book and look up post-op visit, which gives you the code 99024. Turning to the Medicine section, you will see that 99024 is indeed for a postoperative visit. This would be the code you would use for this part of the question.
The next code will be for the diagnostic imaging of the optic nerve. You will turn back to the index and look up ophthalmology, diagnostic, computerized scanning, posterior,
which gives you a code range of 92133-92134. Turning back to the Medicine section, you will see the difference in the range is the part of the eye they are scanning. The optic nerve is viewed using code 92133, so this would be your answer for this part of the question. Finally, you will code the emergent-basis visit. Going back to the visit, you will look up office medical services, emergency care. This gives you the code 99058, which again will be looked up in the Medicine section. As you can see, once you look up the code, code 99058 is for services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic services.
This means that when a patient is brought into the office on an emergent basis, it disrupts the regularly scheduled patient flow. In the case of the scenario in the question, the flow of patients was disrupted in order to bring this patient in on an emergent basis. Therefore, you can use 99058 for this part of the question.
Code 92133 is for a bilateral view of the eyes, meaning that you do not need to bill separate right and left views for this code. So, this would not be the correct answer to this question. Code 99058 must be billed with either an E/M service or the postoperative code. If it is coded by itself, then this is not the correct answer.
Reference:
AMA CPT® 2023 Professional Edition. Pg 743, 849-850
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