Code: 92004
Description: Comprehensive eye examination including elements of a new patient examination, often more extensive
Context: This code is used for comprehensive eye examinations specifically for new patients. It involves a detailed and complete evaluation of the eye and adnexal structures, usually more extensive than routine eye examinations.

Guidelines for Proper Use

• Comprehensive Eye Examination for New Patients: Apply 92004 for detailed eye examinations of new patients. This includes a full assessment of the patient’s vision and eye health.
• Documentation of Examination Details: Ensure healthcare providers’ documentation reflects the comprehensive nature of the eye examination. This should include all tests performed, findings, and any treatment plans.
• Distinction from Established Patient Examinations: Do not use 92004 for subsequent eye examinations of established patients. There are specific codes for established patient eye exams.
• Inclusion of Various Examination Components: This code covers a range of examination elements, such as assessment of visual acuity, ocular motility, visual fields, and health of ocular structures.
• Compliance with Ophthalmic Examination Protocols: Use 92004 in accordance with standard ophthalmic examination guidelines and protocols, as well as payer-specific rules.

Common Misuses of 92004

• Using for Established Patient Examinations: A common misuse is applying 92004 for the examination of established patients. This code is designated for new patients.
• Confusion with Intermediate Eye Examinations: Misuse occurs if 92004 is used for intermediate or less comprehensive eye examinations.
• Omission of Comprehensive Examination Elements: This code should not be used if the examination is not comprehensive in nature, covering all necessary aspects of a full eye examination for a new patient.