tci E/M Coding Alert - 2019 Issue 5

Reader Question: Don’t Look for Easy Answers in the Specialty Vs. E/M Service Debate

Question: What criteria should eye care practices use when deciding between E/M codes and ophthalmological services codes? Arizona Subscriber Answer: There is no one guideline that dictates when you should use one code set versus the other. Some practices maintain internal guidelines that dictate when they use one code set instead of the other, while other offices make the decision on a case-by-case basis. You’ll find that certain codes have more stringent guidelines and bullet points that need to be met than others. For example, some practices exclusively use the eye codes for routine eye exams but find...

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