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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

Chapter 110 an overview of the ocular system.

Alan Kozarsky .

The examiner's ability to help a patient clarify or elaborate on an ocular symptom and the examiner's knowledge of the significance of some common ocular symptoms will often facilitate correct diagnosis on the basis of history alone.

When a patient complains of eye pain ( Chapter 112 ), it is essential to describe the ocular discomfort clearly. The examiner must differentiate between itching, tearing, burning, foreign body sensation, photophobia, deep pain, pain on eye movement, or tenderness to touch. Frequently, the patient will have more than one type of symptom and the examiner must ask, "Which part of your eye problem is most disturbing to you?"

Itching of the lids and conjunctiva is a fairly specific symptom that may be associated with surface allergy, hay fever, or other forms of Type I immediate hypersensitivity. Burning is an external ocular symptom as occurs commonly in conjunctivitis. Foreign body sensation is more specific and occurs when there is a break in the corneal epithelium, exposing sensitive corneal nerves to the opening and closing of the eyelids (e.g., corneal abrasion).

In contrast, photophobia, painful spasm on exposure to bright light, often accompanies intraocular inflammation and therefore has to be separated from more mundane complaints, such as burning. By asking the patient whether there is a "headache" around the eye that is worse in bright light will often clarify the complaint as being photophobia. Deep pain or discomfort on eye movements is a rather specific symptom associated with retrobulbar neuritis and is due to the proximity of the extraocular muscles to the inflamed optic nerve. Tenderness to touch is an uncommon ophthalmic symptom that may be seen in episcleritis and scleritis.

Acute decrease in visual acuity ( Chapter 111 ) should be an alarming symptom to both the patient and the examiner. A few simple questions will often help in the diagnostic thought process. Acute loss of vision is usually in one eye only. In the older patient, common causes include retinal vascular disease and acute ischemic optic neuropathy, the latter sometimes associated with temporal arteritis. In the younger patient, unilateral central visual loss may be associated with retrobulbar neuritis with deep pain on eye movements supporting this diagnosis. Visual loss associated with flashes of light (photopsia) and floaters should make one think of retinal detachment. A diabetic with sudden unilateral visual loss often has a vitreous hemorrhage due to proliferative retinopathy.

Reversible central visual loss is seen in amaurosis fugax and occasionally in migraine. In the former, visual loss is nearly complete in one eye and is signaled by the sensation of drawing down a curtain with restoration of acuity always occurring within several minutes. Migraine may start with central scintillation and distortion spreading to the periphery of visual and often followed by a typical migraine headache.

Gradually occurring, painless loss of vision is seen commonly with cataracts, advanced glaucoma, and retinopathy, especially degenerative retinopathy in the elderly.

Diplopia, or double vision ( Chapter 113 ), is a highly significant symptom frequently signifying the presence of neurologic disease and must be separated from symptoms that do not represent diplopia. One must establish that the patient truly means that they have double vision rather than just blurred vision. One may ask, "Do things seem very blurry, or when you look across the room, do you really see two of everything"? If the answer to this question is yes, the next step is to eliminate the rare possibility of monocular diplopia. Simply tell the patient to cover one eye or the other and ask whether the double vision goes away. If occlusion of one eye relieves double vision, then one has established true diplopia.

One then asks whether the two images seen are side by side or vertically displaced. By far, the most common answer is horizontal displacement. In an acute setting, this usually implies dysfunction of either a medial rectus muscle (cranial nerve III) or lateral rectus muscle (cranial nerve VI). If double vision is worse when looking at distant objects than at nearby objects, difficulty in divergence is suggested making a sixth nerve paresis more likely. Conversely, greater horizontal diplopia at near than at distance represents difficulty in convergence, with a third nerve paresis (medial rectus) more likely. Finally, variability in diplopia increasing with fatigue toward the end of the day is highly suggestive of myasthenia gravis.

Other visual disturbances may be reported. Blurred vision is a frequent complaint of diabetics with recent episodes of elevation of blood glucose caused by reversible osmotic swelling of the crystalline lens. "Floaters" are extremely common and represent minute opacities suspended in the posterior aspect of the vitreous gel. Photopsia, the visual sensation of seeing tiny flashes of light, is usually caused by mechanical traction on the retina and is often seen with retinal detachment. Light scintillation and visual disturbance and metamorphopsia, or alteration of form, may precede migrainous headaches, although metamorphopsia alone may be associated with swelling or deformation of the retina.

• Ophthalmic Examination

Table 110.1 lists the equipment used for examining the eye.

Table 110.1

Instruments used in the eye examination.

General inspection of the eyes and adnexa is discussed in Chapter 114 . It is important to get an overview of the patient. This is especially true if the patient has external ocular complaints. Specifically, if the eyes or eyelids are inflamed, the general pattern of inflammation should be described. Pale, boggy swelling of all four eyelids is certainly seen in classic allergic reactions, while eczematous changes of the lower eyelids are associated with hypersensitivity to topical medications. If external inflammation is present, by all means palpate for preauricular and submandibular nodes, as these enlarge in viral conjunctivitis and Parinaud's oculoglandular syndrome. Finally, is one eye more prominent or proptotic than the other?

Central visual acuity ( Chapter 115 ) is the "vital sign" of the ophthalmic examination. The documentation of good visual acuity in an eye establishes the presence of a near normal refraction, clear ocular media, good retinal function, and intact afferent neuropathways and cortical functioning. The use of an eye chart at 20 feet (6 m) is certainly not appropriate for all clinical settings. Even at the bedside, however, a hand-held visual acuity card or small newsprint can be used to estimate the patient's visual acuity. It is essential when measuring visual acuity at neat distances in patients older than 40 years of age that reading glasses, if customarily used, should be worn.

Testing the visual fields ( Chapter 116 ) by confrontation can detect conditions affecting the optic chiasm, tracts, and visual cortex. The patient is instructed to cover one eye and look directly into the examiner's eye ( Figure 110.1 ). Simultaneously, the examiner can make small hand movements in the periphery of his or her own visual field, telling the patient to say "now" with the first awareness of any movement. With confrontation testing, one is concerned with and most likely to find dense visual field loss as seen in cortical and chiasmal lesions.

Figure 110.1

Examination of the visual fields by confrontation. With the examiner approximately 18 inches (45 cm) from the patient, the patient's fellow eye is covered; the examiner makes small finger movements, asking the patient for an immediate "now" when movement (more...)

Proper alignment of the eyes and extraocular motility can be easily ascertained with brief examination. A penlight, held 18 inches (45 cm) from the patient's eyes, is aimed directly into the pupils with the patient looking at the light ( Figure 110.2 ). The resultant light reflex should be in the same relative position on both corneas. The examiner then uses his or her hand to immobilize the patient's head and tells the patient to follow the penlight. The examiner then moves the penlight to both horizontal extremes as well as upward and downward, observing for appropriate movement of the patient's eyes. The corneal reflex should remain symmetrical in both eyes as they move, and the patient should continue to see one light throughout the examination.

Figure 110.2

The corneal light reflex. By directly shining a penlight into the patient's pupils from a distance of 18 inches (45 cm) and instructing the patient to look directly at the light, a minified reflection of the penlight can be seen on each cornea. If the (more...)

To examine the pupils , the level of the ambient light should be reduced and, to relax accommodation, the patient should be directed to look at a distant object. Using a penlight directed from below, just barely illuminating the pupils, one inspects for symmetry in pupillary size. The patient continues to view a distant object, and each pupil is tested separately for constriction in response to bright light.

The penlight is then quickly moved from one pupil to the other, shining light directly into each eye (the "swinging penlight test" to elicit afferent pupillary defect) In this test, one is specifically looking for a pupil that dilates as the light is first directed toward it, demonstrating greater consensual than direct response. The afferent pupillary defect is also known as a Marcus Gunn pupil.

If any discrepancy of more than 1 mm in pupillary size is found, the pupils are measured in both bright and reduced ambient light. Differences in pupillary size (aniso-coria) tend to be physiologic and not pathologic if such differences are only 1 to 2 mm and remain the same in differing levels of ambient light.

A penlight is used examine the anterior segment of the eye, namely, the cornea, anterior chamber, iris, and pupil. The cornea is generally crystal clear, and opacities without inflammation usually represent old scars. The anterior segment should be appreciated as a three-dimensional structure, especially when viewed from the side. The cornea has a domed convexity with the iris and pupil in a single plane several millimeters posterior to the apex of the cornea. In most patients the three-dimensionality of the anterior segment can be easily observed.

A shallow anterior chamber (i.e., predisposition to acute angle closure glaucoma) should be suspected when the iris and pupil appear as if they were painted on the back of the cornea. This loss of three-dimensionality often identifies the shallow anterior chamber, and a patient with such a configuration should not be dilated pharmacologically. Irregularity in pupillary shape, usually the result of previous inflammation or surgery, should be described.

For the fundus examination ( Chapter 117 ), the patient is directed to look straight ahead at a distant object. The ophthalmoscope is turned to its brightest illumination, the smaller aperture used if the patient is undilated, and the patient is approached from 15 degrees temporally with the ophthalmoscope set on zero ( Figure 110.3 ). It is helpful to tell the patient, "Even though I will be right in front of you, please make believe that you can see through me and continue looking at the object at the end of the room." The examiner then puts the ophthalmoscope to his or her right eye to examine the patient's right eye, approaching from 15 degrees temporally. As the ophthalmoscope approaches the patient's eye, one observes for blood vessels or the optic disk to come into view. The optimal distance between the patient's cornea and the ophthalmoscope is 2.5 cm or less and is best maintained by wrapping one's forefinger around the ophthalmoscope and resting the finger and ophthalmoscope on the patient's cheek to stabilize the viewing arrangement. As soon as a retinal blood vessel or the disk comes into view, the focusing wheel of the ophthalmoscope is moved one way or the other to achieve the clearest image. If a retinal vessel is found first, one searches for a vascular bifurcation "showing the way" to the optic disk (i.e., vessels bifurcate as they course away from the disk toward the retinal periphery).

Figure 110.3

Use of the ophthalmoscope. The patient's right eye is approached from 15 degrees temporally with the examiner setting the ophthalmoscope at zero, holding it in the right hand, and observing with the right eye. A red reflex is observed and the ophthalmoscope (more...)

With the disk in view, one inspects from the center outward. First, identify the borders of the optic cup and the proportion of its horizontal diameter to the total diameter of the disk (cup/disk ratio). The substance of the disk is then examined to be sure that it is pink and healthy and that its margins are clear and sharp.

Subtle undulation in the caliber and the light reflex of the retinal venules adjacent to the optic disk represents venous pulsation, which is normal, occurs with the heartbeat, and should be recorded if present. The venules are somewhat darker and larger in caliber than the arterioles. The normal arteriole to venule diameter ratio is 2:3. Decreases in this ratio are seen in arteriolosclerosis as associated with hypertension.

The posterior pole of the retina is then examined systematically. First, one follows the superonasal arteriole and venule leaving the disk as far in the periphery as possible. This is repeated with the inferonasal vessels, the inferotemporal vessels, and then the superotemporal vessels. Finally, the fovea is visualized by directing attention several disk diameters temporal to the disk and very slightly inferiorly. This maneuver is saved for last because this is the most sensitive portion of the retina to bright light. The foveal reflex will be seen and often has a slightly yellowish surrounding area (macula lutea).

The identical procedure is then carried out on the patient's left eye, using the left eye for viewing.

• Cite this Page Kozarsky A. An Overview of the Ocular System. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 110.
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Meaning of ocular in English

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• accommodative
• age-related macular degeneration
• dispensing optician
• horn-rimmed
• long-sighted
• long-sightedness
• macular degeneration
• ophthalmology
• short-sighted
• wraparounds

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something dangerous or serious, such as an accident, that happens suddenly or unexpectedly and needs fast action in order to avoid harmful results

Paying attention and listening intently: talking about concentration

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8 Questions to Ask During the Ocular Visit at The Wedding Venue

April 5, 2021

You have researched well enough the best wedding venues you can find based on your preferences, and definitely, the ocular visit should be next on your list! It’s important to actually see and experience first-hand each venue’s ambianc right before you settle the reservation fee.

While most of couples tend to get excited as they have seen the venue, there are still a couple of questions you need to ask during the ocular visit to the wedding venue you have chosen.

We have prepared a list of questions you can use to help you focus further on the wedding planning process, aside from checking multiple wedding venues for your big day.

What do the previous clients say about this wedding venue?

We know you’re busy organizing tasks for the wedding preparation, but it’s an integral part of checking what others say about the wedding venue. Basically, if you search specific wedding venue online, you will find tons of reviews.

You will be surprised by the mixed reviews you will find on Facebook, Instagram, and their website. If you notice a problem or two that can be easily explained by one of their staff, or somehow amenable that maybe a cause of miscommunication.

Is there an alternative area if it rains?

Weather is unpredictable, and you cannot determine if tomorrow will be a sunny day. This question is essential to include in your questionnaire, if you’re considering having an outdoor wedding. 

It would help if you chose an established wedding venue that can offer you a backup plan or with a pretty indoor space when it rains.

How many people does the venue can accommodate?

This will answer your question quickly if your chosen venue is ideal to your wedding. Before you set your heart on the wedding venue, it should have the capacity to accommodate your guest list.

If not, proceed to the wedding venue on your list.

Do they have alcohol restrictions?

Drinking tradition has been part of the wedding culture all around the world. You can ask the wedding venue management team during the ocular visit if they have bar options you can add during and after the wedding reception.

For your perusal and lucky enough to find a wedding gem that offers bar options, here are the three different types of bar choices:

• Cash Bar – This only means that your guests should pay for their drinks.
• California Bar – One of the generous bar options you can provide for your friends and family during the wedding reception. Whereas you will cover the total cost of beer and wine.
• Full Bar – If you have enough budget to let the guests have fun and spend the day as a married couple, then a full bar is the best option you should choose.  The full bar means you will cover all the costs of drinks with all the available liquor options.

Is it accessible?

You absolutely want all the guests to be there on your big day, right? The wedding venue should have close proximity to transportation modes.

How many hours does the rental cover?

Let’s say the wedding ceremony is within 30 minutes or 1 hour, and reception may last up to 4 hours. You definitely want to know how many hours you can use the wedding venue.

You can then determine if the wedding planner can implement reception program within the rental hours.

Do they have a resident music band?

If you want to have a music band or DJ for the wedding reception, ask the wedding venue host if it’s possible for them to book a band for you. Or else, you can bring in your favorite music band or a group of talented friends.

What’s the deposit or refund policy?

Wedding venues will require a security deposit to save the reserve slot for you, and it’s highly recommended to know about the venue’s deposit and refund policy.

During these past few months, mass gathering is restricted, and there are only a selected number of guests allowed in wedding venues. Knowing the venue’s deposit and refund policy will put your mind at ease.

Some places will refund most of the amount you have settled with them, while the others opted to refund only the half amount.

Final thoughts

To ensure you don’t miss out on any questions during the ocular visit to the wedding venue, feel free to use these questions.

If you enjoyed this article, we have some more helpful articles below.

 Father of the Bride Speech Examples and Ideas

 How To Find Wedding Inspiration

Cheap But Classy Wedding Reception Ideas

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Definition of 'ocular'

ocular in British English

Ocular in american english, examples of 'ocular' in a sentence ocular, trends of ocular.

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• exophthalmos

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What is ocular visit?

a tour or navigation tour

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In microbiology what is the most commonly used ocular?

The most commonly used ocular is the 10x. If you were to have a higher ocular you would not be able to see the details.

Difference between ocular and objective lens?

the ocular lens sits higher up, closer to your eye. the objective lens are in the objective tube below the ocular lens

What is the function of the ocular compensating ring?

The ocular lenses is the eyepiece the viewer looks through on a microscope. The compensation ring allows the viewer to adjust the focus.

What is an ocular ring?

Why don't microscope makers use 100x ocular lenses.

Why don't micorscope makers use 100x ocular lenses?

Are there samples of formal letter requesting for an occular in a hotel that I can see?

Sample letters for ocular visit to hotel

Where online can one purchase Ocular Sciences contact lenses?

If wanting to purchase Ocular Sciences contact lenses, it is best to visit a local opticians. If wanting to purchase online to get a better deal or discount, Specsavers online is at the top of the search.

Sentence with the word Ocular in it?

"He activated his ocular enhancement system." "Could you give me a sentence with the word 'ocular' in it?" ^just kidding on that one^ "The ocular chart is easy to read."

When was Ocular Digital created?

Ocular Digital was created in 2003.

What is the function of ocular?

The ocular magnifies the already magnified image coming from the objective. The ocular usually magnifies that image 10 times.

What do the ocular lens do on the microscope?

The ocular lens magnify the image 10x.

What do the ocular lens do on a microscope?

An ocular may be fitted to replace a missing eyeball.

ocular prosthesis

How do you use the word ocular in a sentence?

This means related to the eye or eyesight. Here are some sentences.The ocular chart is easy to read.The doctor told me to do ocular exercises to strengthen my eyes.My ocular muscles are tired.

When was Pathogenic Ocular Dissonance created?

Pathogenic Ocular Dissonance was created in 1992.

How do you use ocular in a sentence?

Nicole said look at his Ocular its HUGE! Save

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of, relating to, or for the eyes: ocular movements.

of the nature of an eye: an ocular organ.

performed or perceived by the eye or eyesight.

Optics . eyepiece .

Origin of ocular

Other words from ocular.

• oc·u·lar·ly, adverb
• pre·oc·u·lar, adjective
• sub·oc·u·lar, adjective
• sub·oc·u·lar·ly, adverb
• su·per·oc·u·lar, adjective
• su·per·oc·u·lar·ly, adverb
• trans·oc·u·lar, adjective
• un·oc·u·lar, adjective

Words Nearby ocular

• octuplicate
• octyl alcohol
• octyl phenol
• oculoauriculovertebral dysplasia

Dictionary.com Unabridged Based on the Random House Unabridged Dictionary, © Random House, Inc. 2024

How to use ocular in a sentence

That stands for spaceflight-associated neuro- ocular syndrome.

He has obsessive-compulsive disorder and ocular motor sensory deficit (he has trouble reading).

But before he can explain why, a knife-wielding assailant conducts some brutal ocular surgery on the screaming bureaucrat.

But for the delinquency of his son, she had ocular demonstration; and her indignation was hardly to be repressed.

George stared in his face and rubbed his eyes, too, for he thought he must be under an ocular delusion.

ocular proof I can now offer in the shape of five living eggs of this gigantic bird.

Hence, we must counteract the ocular deception by an adjustment of proportions.

I will answer the question, and show thee, by ocular proof, very soon.

British Dictionary definitions for ocular

/ ( ˈɒkjʊlə ) /

of or relating to the eye

another name for eyepiece

Derived forms of ocular

• ocularly , adverb

Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012

Scientific definitions for ocular

[ ŏk ′ yə-lər ]

Of or relating to the eye or the sense of vision.

The eyepiece of a microscope, telescope, or other optical instrument.

The American Heritage® Science Dictionary Copyright © 2011. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved.

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oc·u·lar

Patient discussion about ocular.

Q. I have been having chronic pain in sinus area and behind my eyes, been to ENT who states it is not infection? I wake up with the pain and go to sleep in severe pain. Its all day and all night. Dr insists that its migraine related and allergy related. I have chronic postnasal drainage. It started 4 months ago when I moved into our new house. The pain makes me extremely fatigue and dizzy at times. I have been referred to the eye doctor, a headache specialist and an allergy specialist. Just recently I have had a CT scan and an MRI, as well as xrays of my sinus. Nothing other than a deviated septum and possible allergies from an ENT has been diagnosed. In the mean time I am waiting for the days to come when I can get into see these specialist. Anyone out there have any of the same symptoms?? Need help here. Soooooo sick of the pain. A. i have chronic sinusitis and can really relate to what you describe. learned to live with the pain...but still, i use various ways to reduce inflammation in my sinuses, i heat the place up before going to sleep, try to avoid eating or drinking cold stuff. another thing i do is i heat water (80c) then add a special oil i bought in a chinese medicine store , about 5 drops, and inhale the fumes. nettle tea can do wonders too.

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How to Choose Between E/M and Eye Visit Codes

• Mark Complete

When billing for office visits, ophthalmologists have two options or types of office visit codes to choose from: evaluation and management (E/M) codes (992XX) and eye visit codes (920XX). One of the most frequent questions we receive at [email protected] is, “Which one should I use?” 

To answer this question, you’ll need to learn about the E/M and eye visit codes, know when not to bill an eye code for a visit, and familiarize yourself with certain procedures and the appropriate codes. 

Differences Between E/M and Eye Visit Codes

First and foremost, you need to understand the unique documentation requirements for the two options.

On Jan. 1, 2021, office-based E/M codes were completely redefined. With these updates, the office or other outpatient services use either 1) medical decision-making (MDM) or 2) total physician time to select a code level. History and examination elements are not used in code selection but still need to be documented as medically relevant. You as the physician decide what is medically necessary for each history and examination. The critical medical decision-making component is comprised of three different components: 

• The number and complexity of problems addressed at the encounter
• The amount and/or complexity of data to be reviewed and analyzed
• The risk of complications and/or morbidity or mortality of patient management

To determine the level of E/M code, you can use the Academy’s Final Determination Table for Medical Decision-Making tool along with aspects of the three components above. You must meet or exceed two of three categories at the same level of complexity for E/M code selection. Make sure your documentation supports your billing level.

Additional information and examples for E/M codes can be found at aao.org/em .

Eye Visit Codes 

The Eye visit codes for both new and established patients have two classifications: comprehensive and intermediate. The Academy has developed guidance on how to appropriately document for both intermediate and comprehensive Eye visit code services outlined in the chart below. 

The history and general medical observations requirements are not defined. Chief complaint, the reason why the patient is there, is always required.  Eye visit codes always require the initiation or continuation of diagnostic and treatment programs and may include, but are not limited to: prescribing medication, arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services. Essentially you need to state what the problem is and what you recommend doing about it. 

What about dilation? The Comprehensive Eye code exam often includes — as indicated — biomicroscopy, exam with cycloplegia or mydriasis and tonometry. If dilation is not performed, documentation must clearly state why. Dilation is not a requirement for E/M codes. 

Fact Sheet for the Comprehensive Eye Visit Codes: 92004 and 92014

When Not to Bill an Eye Visit Code  

Systemic diseases such as Lupus, multiple sclerosis, and rheumatoid arthritis are all covered with E/M codes but not always covered with Eye visit codes. Some payers have frequency edits, or limits on how often you can bill eye visit codes in a year. Payers do not have frequency edits for E/M codes. Eye visit code use may be restricted by some commercial payers to routine/annual exam or vision plans. These same payers may also only permit use of E/M codes for medical diagnoses. Payer allowable is considering the amount payers reimburse for these codes and is discussed in detail below.     

For additional information about each of these scenarios, review the Nine Scenarios When You Should Not Use an Eye Visit Code - American Academy of Ophthalmology (aao.org) .

New vs. Established

This is an important code selection and reimbursement consideration for both E/M and eye visit codes. Review the rules at Is the Patient New or Established? Test Your Knowledge .   

Code Selection

Now that you have reviewed your documentation, confirmed the appropriate level of E/M and/or eye visit code, and have taken into consideration the nine scenarios when not to use an eye visit code, you may find that either an E/M or an eye visit could could work. When both E/M and eye visit codes can be billed, consider billing the code with the highest allowable for that payer. To help determine this, create a simple spreadsheet that lists the allowables for office-based E/M and eye visit codes, for at least five of your top payers.

Hypothetical table listing the allowable payments for both E/M and Eye code visits for two commercial plans and Medicare. A table like this can help you understand which code to use when evaluating patients in the office.

When using E/M codes, all payers let you bill these codes as often as medically necessary. In addition, payers allow unrestricted diagnosis coverage. Medicare Part B doesn’t limit frequency for eye visit codes either; this includes comprehensive exams. Commercial payers vary, thus it is important  \ to know the top payers’ guidelines and the 9 scenarios above. 

Here are three example scenarios where you can test your understandiing of the information above.

Scenario 1 

New patient cataract evaluation with Medicare. Documentation supports a new patient level 4 E/M code, 99204. The documentation also supports a comprehensive Eye visit code 92004. The Medicare allowable for 99204 is $185.26. The allowable for 92004 is $165.97. What code would you choose? 

Answer: Choose 99204, as it has almost a $20.00 higher allowable than 92004.

Established patient with commercial insurance #1 comes in for pain in both eyes. The patient had a routine examination previously with you earlier this year. Documentation supports an established level 3 E/M code, 99213 with an allowable of $142.80. The documentation also supports an established intermediate Eye visit code, 92012 with an allowable of $170.10. Which code would you choose? 

Answer: 99213. Why? The commercial insurance has a frequency edit of only allowing one eye code per year for the routine eye examination. If you were to bill the 92012 based on the higher allowable amount when the payer had a frequency limitation the claim could be denied and the patient could be responsible for payment.

Dry AMD Patient with commercial insurance #2 who was last seen in your practice two years ago by one of your colleagues but is new to you. Both eyes are stable, you recommend AREDS and monitor with amsler grid. Documentation supports either a level 3 E/M code and a comprehensive eye visit code. Note that the AREDS vitamins (OTC medication) do not count toward prescription drug management for the risk category. How should you code? 

Answer: 99213. The patient is considered an established patient. This commercial insurance requires E/M codes when a medical diagnosis is the primary diagnosis and only accepts eye visit codes for routine or annual exams. 

This process can seem daunting at first, but just like everything else you have learned in your training, the more you do something the easier it becomes. It would be easier to bill only eye visit or only E/M codes all the time, but this is not appropriate. Learning the differences and rules will be worth the 

About the author: Matthew Baugh, MHA, COT, OCS, OCSR, is an Academy manager of coding and reimbursement.

The American Academy of Ophthalmology's newsletter for young ophthalmologists (YOs) — those in training as well as in their first few years in practice.

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Evan Silverstein, MD — Chair Sruthi Arepalli, MD Grayson W. Armstrong, MD Liane O. Dallalzadeh, MD Cherie A. Fathy, MD Bradley S. Henriksen, MD L. Claire Peterson, FRCOphth, MBBS Dagny C. Zhu, MD 

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