Ophthalmology
Healthcare IT and billing built for an ophthalmology practice
Eye code versus E/M selection, diagnostic imaging and surgical billing for eye care practices.
Why ophthalmology is different
Ophthalmology carries a coding decision no other specialty has: whether to bill general ophthalmological service codes or standard E/M codes, a choice that affects payment on nearly every encounter.
Healthcare SBC supports that decision with documentation-driven guidance, alongside diagnostic imaging billing, surgical global period tracking, and optical dispensary management for practices with a retail component.
Common challenges
Where ophthalmology practices lose revenue
The billing and workflow problems specific to this specialty, and the ones generic systems handle badly.
Eye codes versus E/M
Choosing the more advantageous and better-supported code family on each visit requires knowing both rule sets.
Diagnostic test frequency limits
OCT, visual fields and fundus photography carry payer frequency limits that produce denials when exceeded.
Surgical global periods
Cataract and other ophthalmic surgeries have global periods complicated by bilateral and staged procedures.
Optical dispensary integration
Retail optical sales, vision plan claims and medical claims must be tracked separately but reconciled together.
How we address it
Built for ophthalmology workflows
- Documentation-driven guidance on eye code versus E/M selection
- Frequency limit tracking for OCT, visual field and imaging studies
- Bilateral and staged surgical modifier logic
- Vision plan and medical plan dual-billing workflows
- Integrated optical dispensary inventory and point-of-sale
Commonly billed codes in ophthalmology
A sample of the codes our ophthalmology coders work with daily.
- 92014Ophthalmological services, established patient, comprehensive
- 92134OCT of retina
- 92083Visual field examination, extended
- 66984Cataract extraction with intraocular lens insertion
- 67028Intravitreal injection of pharmacologic agent
Codes shown for reference only. Verify against current code sets and payer policy.
Other surgical specialties
Orthopedics
Surgical global periods, DME, imaging and therapy billing unified for orthopedic groups.
General Surgery
Surgical scheduling, global period management and multi-facility coordination for surgical practices.
Podiatry
Routine foot care coverage rules, DME dispensing and wound care documentation for podiatric practices.
FAQ
Ophthalmology, frequently asked questions questions
- Should we bill eye codes or E/M codes?
- It depends on the documentation and the payer's fee schedule for each. The platform evaluates what the note supports under both sets and surfaces the correctly billable option, rather than defaulting to one family out of habit.
- How do you handle diagnostic test frequency limits?
- Payer-specific frequency limits for OCT, visual fields and fundus photography are tracked per patient, with alerts when a test would fall outside the covered interval: before it's performed rather than after it's denied.
- Can you bill both vision and medical plans?
- Yes. The platform manages routine vision claims and medical ophthalmology claims separately, applying the correct payer per service, and reconciles optical dispensary revenue alongside professional billing.
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