🎯 CPT Code 92002: Ophthalmological Services, New Patient, Intermediate

Short Definition

Intermediate ophthalmological examination and evaluation for a new patient with initiation of diagnostic and treatment program

Long Definition

CPT 92002 represents an intermediate level ophthalmological service for a new patient who has not been seen by the physician or another physician of the same specialty in the same group practice within the past three years. This code includes a focused medical examination and evaluation of the eye(s) and visual system, with the initiation or continuation of a diagnostic and treatment program. The service includes a problem-focused history, general medical observation, external ocular and adnexal examination, ophthalmoscopic examination, and initiation of diagnostic and treatment program. The examination is less comprehensive than code 92004 but more than a minimal service.

Descriptor: Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient.
Clinical Context: This code is used for the evaluation of a new patient presenting with a new or existing condition complicated by a new diagnostic or management problem. It includes a medically relevant history, general medical observation, external ocular and adnexal examination, and other diagnostic procedures as indicated (often including mydriasis/dilation).
“Intermediate” Definition: Unlike a “Comprehensive” exam (92004) which looks at the complete visual system, an “Intermediate” exam describes an evaluation of a new or existing condition complicated with a new diagnostic or management problem.
“New Patient” Definition: A patient who has not received any professional services from the physician (or another physician of the exact same specialty and subspecialty who belongs to the same group practice) within the past three years.

Reimbursement & Fee Schedule Data

Global Period: XXX (Global concept does not apply).
Assistant Surgeon (Modifier -80/-81/-82/-AS): No.
- Status: The concept of an assistant surgeon does not apply to Evaluation & Management (E/M) or Eye Visit codes.
wRVU: Varies by year (approx. 0.88 - 0.95 work RVUs). Note: Generally reimbursed lower than the comprehensive code 92004.

Coding Requirements: “Initiation of Program”

Mandatory Element: To report 92002 (or any 92xxx series code), the documentation must show the initiation of a diagnostic and treatment program.
What Counts: This includes the prescription of medication, arranging for special ophthalmological diagnostic or treatment services (e.g., scheduling surgery, ordering OCT/Visual Fields), consultations, laboratory procedures, or radiological services.
What Does NOT Count: A simple follow-up of a condition that does not require additional diagnosis or treatment does not constitute a service reported with 92xxx.

Code Tree: Medical Eye Exams (New Patient)

92002: Intermediate exam, new patient.
92004: Comprehensive exam, new patient.
- Differentiation: Use 92004 if the exam covers the complete visual system (often required for complex conditions like cataracts, glaucoma workup, or retinal detachment). Use 92002 for focused problems (e.g., conjunctivitis, specific lid lesion, corneal foreign body).

Comparison: 92002 vs. 99202 -99203 (E/M Codes)

92002 (Eye Code): Focuses on the “Intermediate” eye exam elements and the initiation of a program. Often preferred by ophthalmologists for routine medical checks (e.g., mild cataracts) because reimbursement is often favorable and documentation requirements are specific to eye anatomy.
99202 -99203 (E/M Codes): Focuses on Medical Decision Making (MDM) or Time. Preferred if the patient has high complexity (systemic disease management) or if the visit is primarily counseling/coordination of care.

Compliance & Billing Alerts

Routine vs. Medical:
- If the patient is being seen for a Routine Eye Exam (screening/glasses check with no medical complaint), many commercial payers require HCPCS codes S0620 (Routine ophthalmological examination including refraction; new patient) instead of 92002.
- Reporting 92002 for a purely screening service to secure payment is considered a compliance risk.
Refraction (92015): Refraction is separately billable in addition to 92002. It is not bundled.
Bundling: Do not bill 92002 with 99xxx E/M codes on the same day unless a distinct, separately identifiable service is performed (Modifier -25), which is rare and highly scrutinized.

CPT 92002 - Eye Exam, Intermediate (New)

Description & Explanation: This code reports an intermediate ophthalmological service for a new patient.

New Patient: Has not received any professional services from the physician (or another physician of the same specialty and subspecialty who belongs to the same group practice) within the past 3 years.
Intermediate Service: Describes an evaluation of a new or existing condition complicated with a new diagnostic or management problem. It does not require a comprehensive examination of the entire visual system but must include a history, general medical observation, external ocular and adnexal examination, and other diagnostic procedures as indicated.
Usage: Often used for specific complaints (e.g., “I have a stye” or “My eye is pink”) where a full dilated exam is not medically necessary.

Code Tree:

Medicine
- Ophthalmology
  - General Ophthalmological Services
    - 92002: Eye exam, intermediate, new patient

Technical Data:

WRVU (2025): ~0.95
Global Period: XXX
Assistant Payable: No (Indicator 9)
HCC Information: N/A

Bundling & Edits:

Included: Slit lamp exam, external exam, gross visual fields (if performed).
Excluded: Refraction (92015), Formal Visual Fields (9208x), OCT (9213x).
Mutually Exclusive: E/M codes (99202-99205) on the same day.

Clinical Examples:

Conjunctivitis: A new patient presents with a red, itchy eye. History taken, external exam shows follicular conjunctivitis. Prescribed drops. (No dilation performed).
Corneal Abrasion: A new patient presents with foreign body sensation after scratching eye. Fluorescein stain applied, abrasion noted. Antibiotic ointment prescribed.

Documentation Checklist

Status: Confirmed patient has not been seen in the practice (same specialty) in 3 years.
History: Medically relevant history documented.
Exam: External ocular/adnexal exam performed.
Action: “Initiation of diagnostic and treatment program” is clearly documented (e.g., “Start antibiotics,” “Order HVF,” “Refer for surgery”).

Area of Body

Eye and ocular adnexa, including:

External eye structures (eyelids, conjunctiva, cornea, sclera)
Anterior segment (iris, lens, anterior chamber)
Posterior segment (retina, optic nerve, macula, vitreous)
Ocular motility
Visual pathways

Service Components

Included Services:

Patient history (problem-focused)
Visual acuity testing
External examination of eye and adnexa
Ophthalmoscopic examination (internal eye structures)
General medical observation
Basic diagnostic evaluation
Initiation of treatment program
Medical decision making (straightforward to low complexity)

Excludes:

Refraction services (report separately with 92015)
Special ophthalmological services (92018-92499)
Concurrent E/M services (99201-99215) - these codes are mutually exclusive per NCCI
Diagnostic tests beyond basic examination (report separately)
Comprehensive eye examination (use 92004 instead)

RVU Information

Work RVU (wRVU): 0.92
Total RVU: Approximately 2.14
Global Days: 0
Medicare Status: Active/Payable

HCC Status

Not Applicable - HCC (Hierarchical Condition Category) coding applies only to ICD-10 diagnosis codes, not CPT procedure codes

Assistant Surgeon Status

Assistant Payable: No
CPT 92002 is an evaluation and management service and does not qualify for assistant surgeon modifiers (80, 81, 82, AS). These modifiers are reserved for surgical procedures.

Common Modifiers

Modifier	Description	Usage
-25	Significant, separately identifiable E/M service	Used when a separately identifiable service is performed on the same day as a procedure
-57	Decision for surgery	When the decision for surgery is made during this exam
-52	Reduced services	When the full service described by the code is not performed
-53	Discontinued procedure	When a procedure is discontinued due to circumstances threatening patient well-being
-76	Repeat procedure by same physician	When the same procedure is repeated
-77	Repeat procedure by another physician	When the procedure is repeated by a different physician
-LT	Left side	Indicates procedure performed on left eye
-RT	Right side	Indicates procedure performed on right eye
-59	Distinct procedural service	Used to identify procedures that are not normally reported together but are appropriate

Common Associated CPT Codes

CPT Code	Description	Typical Use with 92002
92015	Refraction determination	Commonly billed separately when refraction is performed
92083	Visual field examination	When visual field testing is medically necessary
92132	Scanning optic nerve analysis	For glaucoma evaluation
92134	Scanning optic nerve analysis with interpretation	Advanced imaging
92250	Fundus photography	Documentation of retinal findings
99070	Supplies and materials	For supplies beyond those included in the exam
J7308	Aminolevulinic acid HCl for ophthalmic use	If pharmaceutical agents are used

Code Tree/Hierarchy

CPT Section: Medicine (90000-99999)
Subsection: Ophthalmology (92002-92499)
Category: General Ophthalmological Services (92002-92014)
Subcategory: New Patient Services
Service Level: Intermediate (Level 2)

Related Codes in Family:

92002 - Intermediate exam, new patient
92004 - Comprehensive exam, new patient
92012 - Intermediate exam, established patient
92014 - Comprehensive exam, established patient

Coding Examples

Example 1: Diabetic Eye Screening

Chief Complaint: New patient referred for diabetic eye screening
Service: Intermediate ophthalmological examination including visual acuity, external examination, dilated fundus exam
Diagnosis: E11.9 (Type 2 diabetes without complications)
Code: 92002
Additional: 92015 (if refraction performed)

Example 2: Red Eye Evaluation

Chief Complaint: 45-year-old new patient presents with red, irritated right eye for 3 days
Service: Focused history, visual acuity check, external examination with slit lamp, ophthalmoscopic examination
Diagnosis: H10.33 (Unspecified acute conjunctivitis, bilateral)
Code: 92002
Modifier: May use RT if documentation specifies right eye only

Example 3: Contact Lens Problem

Chief Complaint: New patient with contact lens discomfort and blurred vision
Service: Problem-focused history, visual acuity, external eye exam, ophthalmoscopy, assessment of contact lens fit
Diagnosis: H52.4 (Presbyopia), Z46.0 (Encounter for fitting and adjustment of contact lenses)
Code: 92002
Additional: Contact lens fitting codes if applicable (92310-92326)

Example 4: Floaters Evaluation

Chief Complaint: New patient reporting sudden onset of floaters in left eye
Service: Intermediate examination including dilated fundoscopic exam to rule out retinal tear or detachment
Diagnosis: H43.399 (Other vitreous opacities, unspecified eye)
Code: 92002 with modifier LT
Note: If comprehensive exam performed, use 92004 instead

Example 5: Glaucoma Suspect

Chief Complaint: Patient referred by optometrist as glaucoma suspect with elevated IOP
Service: Intermediate examination, tonometry, ophthalmoscopy with optic nerve assessment
Diagnosis: H40.001 (Preglaucoma, unspecified, right eye)
Code: 92002
Additional: 92083 (visual field), 92132 (OCT optic nerve) if performed

Documentation Requirements

To support CPT 92002, documentation must include:

Chief complaint and relevant history
Visual acuity measurements
External examination findings
Ophthalmoscopic examination findings
Assessment/impression
Plan for diagnostic workup or treatment
Medical decision making rationale

Billing Guidelines

Cannot be billed with E/M codes (99202-99215) on same date of service for same patient
Three-year rule applies for determining new vs established patient status
Refraction (92015) is typically not covered by Medicare and is patient responsibility
Modifier -25 may be required by some payers when billing with procedures
Documentation must support intermediate level of service
Time is not a factor in code selection for ophthalmological services

Explorer

92002