How To Use CPT Code 92002

CPT 92002 is an intermediate ophthalmological service code for new patients, which includes medical examination, evaluation, and initiation of a diagnostic and treatment program. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 92002.

1. What is CPT 92002?

CPT 92002 is a code used for intermediate ophthalmological services, specifically for new patients. It involves a medical examination and evaluation of the patient’s eye, as well as the initiation of a diagnostic and treatment program. This code is used by medical coders and billers to accurately document and bill for these services.

2. 92002 CPT code description

The official description of CPT code 92002 is: “Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient.”

3. Procedure

The 92002 CPT code procedure involves the following steps:

1. Taking a patient history, including any existing eye problems.
2. Examining the eye and adjacent structures.
3. Performing additional services such as keratometry, routine ophthalmoscopy, retinoscopy, tonometry, or motor evaluation, as needed.
4. Initiating a diagnostic and treatment program based on the evaluation results.

4. Qualifying circumstances

A patient is eligible to receive CPT code 92002 services if they meet the following criteria:

• The patient is considered a new patient, meaning they have not received any professional services from the provider or another provider of the same specialty in the same group practice within the past three years.
• The provider performs an intermediate level ophthalmological evaluation, which includes a history, examination of the eye and adjacent structures, and any necessary additional services.
• The provider initiates a diagnostic and treatment program based on the evaluation results.

5. When to use CPT code 92002

It is appropriate to bill the 92002 CPT code when the provider performs an intermediate level ophthalmological evaluation for a new patient and initiates a diagnostic and treatment program. This code should be used for routine care as well as for patients with existing eye problems.

6. Documentation requirements

To support a claim for CPT 92002, the following information needs to be documented:

• Patient’s history, including any existing eye problems.
• Examination findings of the eye and adjacent structures.
• Results of any additional services performed, such as keratometry, routine ophthalmoscopy, retinoscopy, tonometry, or motor evaluation.
• Details of the diagnostic and treatment program initiated by the provider.

7. Billing guidelines

When billing for CPT code 92002, keep in mind the following guidelines and rules:

• Do not report CPT 92002 in conjunction with 99173, 99174, 99177, or 0469T.
• Choose the code that most accurately describes the service provided, whether it is an eye code or an E/M code, based on the evaluation and treatment performed.
• Ensure that all documentation requirements are met to support the claim for CPT 92002.

8. Historical information

CPT 92002 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 92002

Five similar codes to CPT 92002 and how they differentiate are:

1. CPT 92004: Comprehensive ophthalmological services for new patients, including a complete visual system evaluation and treatment over one or more visits.
2. CPT 92012: Intermediate ophthalmological services for established patients, including evaluation and continuation of a diagnostic and treatment program.
3. CPT 92014: Comprehensive ophthalmological services for established patients, including a complete visual system evaluation and treatment over one or more visits.
4. CPT 99202-99215: E/M codes for office or other outpatient visits, used when the provider evaluates the eye as it relates to a systemic disease process.
5. CPT 99173, 99174, 99177, and 0469T: Codes that should not be reported in conjunction with CPT 92002.

10. Examples

Here are 10 detailed examples of CPT code 92002 procedures:

1. A new patient presents with blurry vision and is evaluated for potential refractive errors, leading to the initiation of a treatment plan involving corrective lenses.
2. A new patient with a history of diabetes undergoes an intermediate ophthalmological evaluation to assess for potential diabetic retinopathy, and a diagnostic and treatment program is initiated.
3. A new patient with a family history of glaucoma undergoes an intermediate ophthalmological evaluation, including tonometry, to assess their risk and initiate a monitoring plan.
4. A new patient presents with red, itchy eyes and is evaluated for potential allergies, leading to the initiation of a treatment plan involving antihistamine eye drops.
5. A new patient with a history of dry eyes undergoes an intermediate ophthalmological evaluation to assess the severity of their condition and initiate a treatment plan involving artificial tears and lifestyle modifications.
6. A new patient presents with eye pain and is evaluated for potential corneal abrasions, leading to the initiation of a treatment plan involving antibiotic eye drops and a follow-up visit.
7. A new patient with a history of cataracts undergoes an intermediate ophthalmological evaluation to assess the progression of their condition and initiate a monitoring plan.
8. A new patient presents with floaters and is evaluated for potential retinal detachment, leading to the initiation of a treatment plan involving laser surgery and a follow-up visit.
9. A new patient with a history of macular degeneration undergoes an intermediate ophthalmological evaluation to assess the progression of their condition and initiate a treatment plan involving nutritional supplements and monitoring.
10. A new patient presents with eye strain and is evaluated for potential computer vision syndrome, leading to the initiation of a treatment plan involving ergonomic adjustments and regular breaks from screen time.