Ophthalmology Revenue Cycle Management Services
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ICD-10 Ophthalmology Superbill Example
| Appointment Date & Time: | Last Seen Date: | ||||
| Patient: | Gender: | DOB: | MR# | Pat Due: | INS Due: |
| Address: | Reason: | ||||
| Home Phone: | Cell Phone: | E-Mail: | |||
| Case Name: | Case No: | Case Type: | Case Date: | ||
| Pr Insurance: | Member ID: | Co-Pay Amount: | Deductible: | ||
| Rendering Provider: | PCP: | Referring Provider: | |||
| CPT CODES | |||||
| CPT Code | Description | CPT Code | Description | CPT Code | Description |
| 92004 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits | 92002 | Ophthalmological services; medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient | 92140 | Provocative tests for glaucoma, with medical diagnostic evaluation, without tonography |
| 92014 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits | D 92004 | Comprehensive, new patient, one or more visits | D 92225 | Ophthalmoscopy, extended as for retinal detachment (may include use of contact lens, drawing or sketch, and/or fundus biomicroscopy), with medical diagnostic evaluation; initial |
| 99204 – 99205 | Office or other outpatient visit for the evaluation and management of a new patient | 92012 | Ophthalmological services; medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient. | D 92226 x | With ophthalmodynamometry |
| 99214 – 99215 | Office or other outpatient visit for the evaluation and management of an established patient; moderate to high complexity | D 92014 | Comprehensive, established patient, One or more visits | D 92250 | With fundus photography |
| 99244 – 99245 | Office consultation for a new or established patient; moderate to high severity; 60-80 minutes | D 92020 | Conioscopy with medical diagnostic evaluation (separate procedure). | D 92260 | With ophthalmodynamometry |
| 92250 | Fundus Photography | 92060 | Sensorimotor examination with medical diagnostic evaluation (separate procedure). | 92270 | Electro-oculography, with medical diagnostic evaluation |
| 76510 | Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter | 92065 | Orthoptic and/or pleoptic training, with continuing medical direction and evaluation | D 92275 | Electroretinography, with medical diagnostic evaluation |
| 76511 | Ophthalmic ultrasound, diagnostic, A-scan only | T 92070 | Fitting of contact lens for treatment of disease, including supply of lens | 92280 | Visually evoked potential (response) study, with medical diagnostic evaluation |
| 76512 | Ophthalmic ultrasound, diagnostic, contact B-scan (with or without A scan) | 92081 | Visual field examination with medical diagnostic evaluation; tangent screen; autoplot or equivalent | 92283 | Color vision examination, extended, e.g., anomaloscope or equivalent |
| 76513 | Ophthalmic ultrasound, diagnostic, immersion (water bath) B-scan | 92082 | Quantitative perimetry, e.g., several isopters on Goldmann perimeter, or equivalent | 92284 | Dark adaptation examination, with medical diagnostic evaluation |
| 76514 | Ophthalmic ultrasound, corneal pachymetry | 92083 | Static and kinetic perimetry, or equivalent | 92285 | External ocular photography for documentation of medical progress |
| 76516 | Ophthalmic biometry by ultrasound, A-scan | 92100 | Serial tonometry with medical diagnostic evaluation (separate procedure), one or more sessions, same day | 92286 | Specular endothelial microscopy with photographic documentation, medical evaluation and report |
| 76519 | Ophthalmic biometry by ultrasound, A-scan w/intraocular lens power calculation | D 92120 | Tonography with medical diagnostic evaluation, recording indentation tonometer method or perilimbal suction method | 65205 | Removal of foreign body, external eye; conjunctival superficial |
| 76529 | Echo exam of eye for foreign body | D 92130 | Tonography with water provocation | 67820 | Correction trichiasis; epilation, forceps only |
| ICD CODES | |||||
| ICD-10 | Description | ICD-10 | Description | ICD-10 | Description |
| H52.00 | Hypermetropia, unspecified eye | H52.513 | Internal ophthalmoplegia (complete) (total), bilateral | D23.10-D23.12 | Other benign neoplasm of skin of eyelid, including canthus |
| H52.01 | Hypermetropia, right eye | H52.519 | Internal ophthalmoplegia (complete) (total), unspecified eye | D31.00-D31.92 | Benign neoplasm of eye and adnexa |
| H52.02 | Hypermetropia, left eye | H52.521 | Paresis of accommodation, right eye | E08.00-E13.9 | Diabetes mellitus |
| H52.03 | Hypermetropia, bilateral | H52.522 | Paresis of accommodation, left eye | G35 | Multiple sclerosis |
| H52.10 | Myopia, unspecified eye | H52.523 | Paresis of accommodation, bilateral | G45.3 | Amaurosis fugax |
| H52.11 | Myopia, right eye | H52.529 | Paresis of accommodation, unspecified eye | G93.0-G93.2 | Other disorders of brain |
| H52.12 | Myopia, left eye | H52.531 | Spasm of accommodation, right eye | H01.001-H02.9 | Other inflammation of eyelid |
| H52.13 | Myopia, bilateral | H52.532 | Spasm of accommodation, left eye | H15.001- H43.9 | Disorders of sclera |
| H52.201 | Unspecified astigmatism, right eye | H52.533 | Spasm of accommodation, bilateral | H44.121- H44.129 | Parasitic endophthalmitis, unspecified |
| H52.202 | Unspecified astigmatism, left eye | H52.539 | Spasm of accommodation, unspecified eye | H44.50- H44.539 | Degenerated conditions of globe |
| H52.203 | Unspecified astigmatism, bilateral | H52.6 | Other disorders of refraction | H44.811- H49.9 | Other disorders of globe |
| H52.209 | Unspecified astigmatism, unspecified eye | H52.7 | Unspecified disorder of refraction | H50.21- H51.9 | Vertical strabismus |
| H52.211 | Irregular astigmatism, right eye | H53.71 | Glare sensitivity | H53.10- H53.489 | Subjective visual disturbances |
| H52.212 | Irregular astigmatism, left eye | H53.72 | Impaired contrast sensitivity | H53.60- H53.69 | Night blindness |
| H52.213 | Irregular astigmatism, bilateral | H53.8 | Other visual disturbances | H54.0- H57.9 | Blindness |
| H52.219 | Irregular astigmatism, unspecified eye | H53.9 | Unspecified visual disturbance | H59.40- H59.43 | Inflammation (infection) of postprocedural bleb |
| H52.221 | Regular astigmatism, right eye | Z01.00 | Encounter for examination of eyes and vision without abnormal findings | Q10.0- Q15.9 | Congenital malformations of eyelid, lacrimal apparatus and orbit |
| H52.222 | Regular astigmatism, left eye | Z01.01 | Encounter for examination of eyes and vision with abnormal findings | R44.1 | Visual hallucinations |
| H52.223 | Regular astigmatism, bilateral | A18.50-A18.59 | Tuberculosis of eye | S00.10XA- S00.279S | Contusion of eyelid and periocular area |
| H52.229 | Regular astigmatism, unspecified eye | A74.0 | Chlamydial conjunctivitis | S05.00XA- S05.12XS | Injury of conjunctiva and corneal abrasion without foreign body |
| H52.31 | Anisometropia | B30.0-B30.9 | Viral conjunctivitis | S05.8X1A-S05.92XS | Other injuries of right eye and orbit |
| H52.32 | Aniseikonia | B39.4-B39.9 | Histoplasmosis | T15.00XA- T15.92XS | Foreign body in cornea |
| H52.4 | Presbyopia | B60.13 | Keratoconjunctivitis due to Acanthamoeba | T85.310A- T85.398S | Breakdown (mechanical) of prosthetic orbit of right eye |
| H52.511 | Internal ophthalmoplegia (complete) (total), right eye | C44.101-C44.199 | Other and unspecified malignant neoplasm of skin of eyelid, including canthus | T86.840- T86.849 | Corneal transplant rejection |
| H52.512 | Internal ophthalmoplegia (complete) (total), left eye | D22.10-D22.12 | Melanocytic nevi of eyelid, including canthus | H53.001- H53.039 | Amblyopia |
| Charges: | CASH | Doctor’s Signature | |||
| Payments: | CHECK: | ||||
| MC | AMX | ||||
| Balance: | VISA | DEBT | |||
| Credit Card# | |||||