The Service Utilization indicator included in VEHSS consists of the proportion of patients who underwent an eye exam per year. The rate of exams represents the proportion of patients who have at least one eye exam during the year of observation, and is a single number representing the average for each patient group.
Table 1. Eye Examination Procedure Codes
|Eye Exams||By any provider type|
|By ophthalmologists and other physicians|
|By optometrists and opticians|
The VEHSS system uses Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCPS) codes to measure service use and access to care in administrative claims and electronic medical registry data. Four CPT/HCPCS codes denote an eye exam, and all instances of these procedures are counted as an eye examination.
Table 2. Eye Examination Procedure Codes
|Code Description||CPT/HCPCS Code|
|Eye exam new patient||92002
|Eye exam established patient||92012|
|Eye exam tx estab pt 1/>vt||92014|
Other Evaluation & Management (E&M) codes are frequently billed for eye examinations but are not specific to eye examinations. E&M codes are counted as an eye examination if they are coded by an eye care provider.
Table 3. Procedure Codes that Require Provider Specialty Code*
|Code Description||E&M Code|
|Office/outpatient visit new||99201
|Office/outpatient visit est||99212
|Home visit new patient||99341
|Home visit est patient||99347
|*See Table 4 for required specialty codes for use of E&M codes in VEHSS.|
E&M codes are counted as an eye examination if the provider type taxonomy indicates that the procedure was coded by an ophthalmologist, optometrist or optician, or a general physician who coded for an ophthalmic procedure.
Table 4. Eye Care Provider Taxonomy Codes
|Medicare Specialty Code||Medicare Provider/Supplier Type Description||Provider Taxonomy Code||Provider Taxonomy Description: Type, Classification, Specialization|
|2||Physician/General Surgery||207WX0200X||Allopathic & Osteopathic Physicians/Ophthalmic Plastic and Reconstructive Surgery|
|18||Physician/ophthalmology||207W00000X||Allopathic & Osteopathic Physicians/Ophthalmology|
|152W00000X||Eye and Vision Service Providers/Optometrist|
|152WC0802X||Eye and Vision Service Providers/Optometrist, Corneal and Contact Management|
|152WL0500X||Eye and Vision Service Providers/Optometrist, Low Vision Rehabilitation|
|152WX0102X||Eye and Vision Service Providers/Optometrist, Occupational Vision|
|152WP0200X||Eye and Vision Service Providers/Optometrist, Pediatrics|
|152WS0006X||Eye and Vision Service Providers/Optometrist, Sports Vision|
|152WV0400X||Eye and Vision Service Providers/Optometrist, Vision Therapy|
|96||Optician||156FX1800X||Eye & Vision Service Providers/Technician/Technologist, Optician|