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MEDTECH A small survey revealed that most physicians use the MDM model for coding, while most optometrists use the Time model.
Navigating the labyrinth of medical billing codes can be a daunting task for any healthcare professional. This overview aims to shed light on the intricacies of optometry and ophthalmology billing codes, offering a clearer understanding of their application and importance.
Key Points:
- Optometry and ophthalmology have two sets of codes for billing medical office visits: Evaluation & Management (E/M) codes and ophthalmology codes.
- E/M codes are defined by history and examination, time, and medical decision making (MDM).
- History and examination are medically appropriate but not used in code selection.
- Time refers to face-to-face time with the patient and/or family, including various activities such as obtaining history, examination, counseling the patient, ordering medications, tests or procedures, referring and communicating with other healthcare professionals, documenting clinical information, interpreting results, and care coordination.
- MDM uses key components such as history, examination, and MDM.
- Ophthalmology codes are based solely on examination, making them a popular choice among optometrists.
Additional Points:
- Some optometrists prefer E/M codes, some prefer only ophthalmology codes, and some use both.
- Optometry often uses time-based coding due to the common practice of scheduling patients in specific “time slots.”
Conclusion:
- Understanding the nuances of these billing codes is crucial for accurate and efficient medical billing. Although the choice between E/M codes and ophthalmology codes often comes down to personal preference and practice style, it’s important to be knowledgeable about both to ensure the best possible billing outcomes.
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“I have heard from numerous sources that frequencies in excess of the unwritten, but standard, industry average of 60 percent comprehensive and 40 percent intermediate, will often times trigger an audit.”
Mark K. Davis, OD
Therapeutic Optometrist and Optometric Glaucoma Specialist
Diplomate, American Board of Optometry
Adjunct Assistant Professor, University of Houston College of Optometry
Chief of Optometry, 147th Medical Group
Lt Col, Texas Air National Guard, Ellington Field JRB
Houston, Texas.
