Optometry Coding Differences In Eye Codes & E/M Codes

Optometry Coding Differences

Optometrists have their hands full when it comes to billing because of the complex nature of procedure optometry coding. Not only are there a large number of codes available, there are two different types of codes to choose from before getting into the specifics. Evaluation and Management codes, otherwise known as E/M codes, are standardized codes across most insurance companies while eye codes can be subject to broader interpretation specific to each insurance carrier. Let’s take a look at the difference to give you more insight into what you are dealing with when handling eye care claims.

What’s the Difference?

Before we delve into the specifics of each type of code, let’s differentiate what each code means. E/M codes are those that every physician uses, regardless of their specialty. Eye codes, on the other hand, are specific to an eye specialist and optometry coding. While some optometrists think this means eye specialists should use only eye codes, this is not the case. Strictly using eye codes can cause issues with insurance companies, reduce reimbursement, and play a role in potential future audits.

Documentation Made Simple

Nothing is easy when it comes to physician billing and optometry coding, but compared to E/M codes, eye codes are definitely much more straightforward. They carry much simpler definitions, making it easy for billing personnel to understand and code it correctly. There are only two types of exams to choose from: comprehensive or intermediate. And the documentation required is fairly straightforward.

The Downside to Eye Codes

Eye codes, while much simpler to understand and easier to use, are not all inclusive. For those patients who have a severe situation occurring, there might not be an appropriate eye code. In these instances, E/M codes are essential. The benefit to the E/M codes is their complexity and variation from lower level codes to more complicated codes for severe situations. In addition, E/M codes are standard throughout the industry, which could mean that there is a more widespread understanding of them. Lastly, some insurance payers interpret eye codes as “routine” even when billed with a medical diagnosis, so over-reliance on eye codes can lead to unnecessary denials.

Putting it all Together

In the end, E/M is a black and white system which most billers understand, regardless of their previous experience. Eye codes, on the other hand, have more discrepancies and nuances to handle, which makes optometry billing a tad more complex. Applied Medical Systems has a staff of experts who fully understand optometry billing and all of its nuances. We handle both eye codes and E/M codes efficiently the first time around, ensuring optimal billing and payments to run a successful practice. We have been in business for the last 30 years, helping physicians, including optometrists, continue to reach financial success.   Contact us today for a free consultation with our optometry billing and coding experts.