One of the coding spheres within the Medicine section in the CPT manual is ophthalmology. This subsection includes codes for general ophthalmological services, special ophthalmological services, contact lens services, and spectacle services (American Medical Association, 2020). There is also one code (92499) for any unlisted ophthalmological procedure or service (American Medical Association, 2020). In brief, the ophthalmological subsection covers all services and procedures related to eye health except for surgical ones.
Now, one can look closer at the structure and descriptions of the codes within this subsection. For example, code 92015 stands for “determination of refractive state” and has two additional parenthetical comments (American Medical Association, 2020, p. 1520). The first one states that 92015 cannot be reported with 99173, 99174, 99177 (American Medical Association, 2020). 99173 denotes “screening test of visual acuity, quantitative, bilateral” (American Medical Association, 2020, pp. 1724-1725). 99174 and 99177 are also mentioned in the second parenthetical comment, which refers the coder to them “for instrument-based ocular screening” (American Medical Association, 2020, p. 1520). The difference between them is whether the analysis is remote or on-site (American Medical Association, 2020). Thus, parenthetical comments provide information on compatibility with other codes within a report or more accurate alternatives.
Another example of a code within the ophthalmological subsection is 92227. It stands for “remote imaging for detection of retinal disease with analysis and report under physician supervision, unilateral or bilateral” (American Medical Association, 2020, p. 1572). The comment states that it cannot be combined with “92002-92014, 92133, 92134, 92250, 92228 or with the evaluation and management of the single organ system, the eye, 99201-99350” (American Medical Association, 2020, p. 1572). Thus, the structural pattern of 92227 is similar to 92015, but it has a specific marking for telemedicine services.
Some procedures require more detailed descriptions than those provided in general CPT codes sections. Therefore, CPT codes may also have modifiers with additional information (Medical Billing & Coding Certification, para. 23). For example, 92015 may have an additional modifier 50 used for bilateral procedures if the determination of refractive state is combined with another procedure during the same session (American Medical Association, 2020). As 92227 is a remote procedure, it can be appended by the modifier 95, which denotes “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system” (American Medical Association, 2020, p. 1849). Thus, modifiers are applied when one needs to make the coding more specific.
References
American Medical Association. (2020). CPT/Current procedural terminology 2021: Professional edition. American Medical Association.
Medical Billing & Coding Certification. (n.d.). Learn more about medical coding. Web.