Understanding Eye Codes
Encompass automatically suggests eye codes (92-codes) and medical codes (E/M or 99-codes) based on the visit documentation. When a visit justifies both types of codes, Encompass automatically selects the eye code. This page explains what documentation is required to justify eye codes and how to review Encompass eye code calculations.
Here are three things to keep in mind regarding recent coding changes:
- Encompass always recommends an eye code over a medical code.
- Starting March 2025, the requirement to select the New Dx or Existing Condition check box along with the diagnosis was removed. This change made intermediate eye codes (92002, 92012) easier to achieve.
- You can quickly compare and switch between suggested 92-codes and 99-codes directly in the visit overview. To see how, go to Converting 99 Codes to 92 Codes.
Document the elements required for an intermediate eye code
The intermediate eye code (92002, 92012) requires three elements:
- Diagnosis
- Diagnostic plan (e.g., follow-up, photos, diagnostic test)
- Treatment plan (e.g., counseling, over-the-counter or prescription treatment, eyeglasses or contacts Rx)
Follow-up plans require the plan Details tab to be completed.
Counseling plans require the plan Decision tab to be completed. Select the check boxes as free-text entries alone won't contribute.
Prior to March 2025, you were required to select the New Dx or Existing Condition check box along with the diagnosis. This selection is no longer required.
Document the elements required for a comprehensive eye code
The comprehensive eye code (92004, 92014) requires several elements.
- CC The main reason for the patient’s visit to the doctor./HPI History of Present Illness. A detailed account of a patient's current health issue, including when it started and how it has changed over time.
- At least one chief complaint
- Vision Exam
- Pupils The round, dark center of the eye, which opens and closes to regulate the amount of light the retina receives.
- Motility (must select a Result)
- Visual Fields (must select a Result)
- Visual Acuities A measurement of visual performance using the letter chart.
- IOP Intraocular Pressure. Eye pressure, as determined by the amount of aqueous humor filling it. High IOP (ocular hypertension) can be a sign of glaucoma.
- Pupils
- Eye Exam
- Dilated To expand the pupil of the eye. Pupils are most commonly dilated during the internal exam. Occasionally pupils are dilated in disease cases as a means of preventing the iris from sticking to the lens of the eye. or Dilated Deferred (not Pt Declined Dilation)
- External Examination of the external portions of the eye. Generally considered to be from the iris forward including the lids, lashes, cornea, conjunctiva, tears, and general facial area.
- Conj
- K
- AC/Iris Colored part of the eye. The iris has muscles that allow it to change the diameter of the opening in the eye (pupil). These muscles regulate the amount of light in the eye.
- Lens
- Discs
- Fundus Tissues at the back of the eye, or retina.
- Misc. (Appearance, Orientation, Mood and affect)
- Dilated
- Impressions and Plans
- Diagnosis
- Diagnostic plan (e.g., follow-up, photos, diagnostic test)
- Treatment plan (e.g., counseling, over-the-counter or prescription treatment, eyeglasses or contacts Rx)
Follow-up plans require the plan Details tab to be completed.
Counseling plans require the plan Decision tab to be completed. Select the check boxes as free-text entries alone won't contribute.
Prior to March 2025, you were required to select the New Dx or Existing Condition check box along with the diagnosis. This selection is no longer required.
Review eye code calculations
The Eye Code Calculation card in the visit overview lists the eye code generated based on the visit documentation. The code is then followed by a table that lists each of the attributes and the justification, or documentation, attributed to each attribute. The following table explains how these attributes relate to the visit note.
| Attribute | Codes | Visit | Notes |
|---|---|---|---|
| Evaluate Complete Visual System | Level 4 |
Vision Exam
Eye Exam
Eye Exam > Misc. tab
|
|
| New condition or Existing Condition with New Problem | Level 2 |
Ocular Exam > Diagnosis or Impressions and Plans > Diagnosis |
Selecting New Dx or Existing Condition is no longer required. |
| Initiate or continue diagnostic and treatment programs | Level 2 Level 4 |
Ocular Exam > Plans or Impressions and Plans > Plans |
You must select a diagnostic plan and a treatment plan Follow-up plans are credited as diagnostic only when the plan's Details tab is completed. Counseling plans are credited as treatment only when the plan's Decision tab is completed. Select the check boxes as free text won't contribute tot he credit. |
| History | Level 2 Level 4 |
CC/HPI | |
| General Medical Observations | Level 2 Level 4 |
Eye Exam > Misc. tab
|
These elements were also required for the Evaluate Complete Visual System |
| Gross Visual Fields | Level 4 | Vision Exam > Visual Fields > Result | The Result defaults to Full to Confrontation OU when Mark as Normal is selected. |
| Basic Sensorimotor Exam | Level 4 | Vision Exam > Motility > Result | The Result defaults to Full OU when Mark as Normal is selected. |
| External Adnexa | Level 2 Level 4 |
Eye Exam > External | This element was also required for the Evaluate Complete Visual System |
| Ophthalmoscopy | Level 4 |
Eye Exam > Dilated or Eye Exam > Deferred (contraindication) |
Pt Declined Dilation does not justify ophthalmoscopy |