Medicare payments for eye exam coding – Ophthalmic Professional

Why you might choose differently this year

In my last column, I briefly reviewed how Evaluation and Management (E/M) exam coding for 2021 had changed as of Jan. 1 . Remember, history and exam elements (other than the reason for presentation, chief complaint) are no longer a relevant consideration for the level of E/M exam code selection.

In that column, I alluded that it was important to understand that the payments for eye exams are not stagnant; they change slightly every year. This year, it may result in your “choosing differently” than you have in the past. In this column, I will discuss what implications the 2021 Final Rule on the Medicare Physician Fee Schedule (MPFS) reimbursement may have on your choice of code. Remember, if an eye exam can meet an eye (920xx) code and an E/M code under the new guidelines (99202-99215), the provider can choose the higher paying of those two and remain in full compliance with coding guidelines.

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, MBA, MMSC, COMT, COE, CPC, CPMA. To view the entire article in Ophthalmic Professional, click on the link below:

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