How To Use CPT Code 92012

CPT 92012 refers to ophthalmological services for an intermediate medical examination and evaluation of an established patient, with initiation or continuation of a diagnostic and treatment program. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 92012.

1. What is CPT 92012?

CPT 92012 is a medical code used to describe ophthalmological services provided to an established patient for an intermediate level eye examination. This code is specifically used when the ophthalmologist initiates or continues a diagnostic and treatment program for the patient.

2. 92012 CPT code description

The official description of CPT code 92012 is: “Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient.”

3. Procedure

1. The ophthalmologist reviews the patient’s medical history and any previous eye examinations.
2. A general examination of the patient’s eyes is conducted, including visual acuity, gross visual fields, and ocular mobility tests.
3. The ophthalmologist examines the patient’s eyelids, adnexa, pupils, iris, conjunctiva, cornea, anterior chamber, and lens.
4. Intraocular pressure is measured, and the retina and optic disc are examined.
5. Based on the findings, the ophthalmologist initiates or continues a diagnostic and treatment program for the patient.

4. Qualifying circumstances

An established patient is eligible to receive CPT 92012 services if they have been seen by the same physician or any physician in the group practice (or any physician of the same specialty billing under the same group number) for a face-to-face service within the past 36 months. The patient must also have a new or existing condition complicated with an acute problem that may not be related to the primary diagnosis.

5. When to use CPT code 92012

It is appropriate to bill the 92012 CPT code when an ophthalmologist sees an established patient for an intermediate level eye examination and initiates or continues a diagnostic and treatment program for the patient. This code should not be used for routine vision exams or comprehensive eye examinations.

6. Documentation requirements

To support a claim for CPT 92012, the following information must be documented:

• Patient’s medical history and previous eye examinations
• Results of the general eye examination, including visual acuity, gross visual fields, and ocular mobility tests
• Findings from the examination of the patient’s eyelids, adnexa, pupils, iris, conjunctiva, cornea, anterior chamber, lens, intraocular pressure, retina, and optic disc
• Diagnosis and treatment plan initiated or continued by the ophthalmologist

7. Billing guidelines

When billing for CPT code 92012, it is essential to follow the specific guidelines and rules set by the insurer. Some insurers may consider 92002-92014 codes to be used only for routine vision exams, so it is crucial to verify the carrier’s rules. Additionally, do not report CPT 92012 in conjunction with 99173, 99174, 99177, or 0469T.

8. Historical information

CPT 92012 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 92012

Five similar codes to CPT 92012 and how they differentiate are:

• CPT 92002: An intermediate eye examination for a new patient
• CPT 92004: A comprehensive eye examination for a new patient
• CPT 92014: A comprehensive eye examination for an established patient, which requires dilation unless medically contraindicated
• CPT 92015: Determination of refractive state
• CPT 92060: Sensorimotor examination, including multiple measurements of ocular deviation

10. Examples

1. An established patient with a history of glaucoma visits the ophthalmologist for a follow-up examination and evaluation of their intraocular pressure.
2. A patient with a known cataract returns for an intermediate examination to assess the progression of the cataract and determine the need for surgery.
3. An established patient with diabetes visits the ophthalmologist for an intermediate examination to evaluate the presence of diabetic retinopathy.
4. A patient with a history of macular degeneration returns for an intermediate examination to monitor the progression of the condition and adjust the treatment plan accordingly.
5. An established patient with a recent onset of floaters and flashes visits the ophthalmologist for an intermediate examination to rule out retinal detachment.
6. A patient with a history of dry eye syndrome returns for an intermediate examination to evaluate the effectiveness of their current treatment plan.
7. An established patient with a corneal abrasion visits the ophthalmologist for a follow-up examination to assess the healing process and adjust the treatment plan if necessary.
8. A patient with a history of uveitis returns for an intermediate examination to monitor the condition and evaluate the need for additional treatment.
9. An established patient with a recent onset of ocular pain and redness visits the ophthalmologist for an intermediate examination to determine the cause and initiate a treatment plan.
10. A patient with a history of ocular hypertension returns for an intermediate examination to monitor the condition and adjust the treatment plan if necessary.