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.

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.

The comprehensive eye code (92004, 92014) requires several elements.

  • CC/HPI
    • At least one chief complaint
  • Vision Exam
    • Pupils
    • Motility (must select a Result)
    • Visual Fields (must select a Result)
    • Visual Acuities
    • IOP
  • Eye Exam
    • Dilated or Dilated Deferred (not Pt Declined Dilation)
    • External
    • Conj
    • K
    • AC/Iris
    • Lens
    • Discs
    • Fundus
    • Misc. (Appearance, Orientation, Mood and affect)
  • 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.

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

  • Pupils
  • Motility
  • Visual fields
  • Visual acuities
  • Intraocular pressure

Eye Exam

  • External
  • Conj
  • K
  • AC/Iris
  • Lens
  • Discs
  • Fundus

Eye Exam > Misc. tab

  • Appearance
  • Orientation
  • Mood and affect
  
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

  • Appearance
  • Orientation
  • Mood and affect
 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