Ophthalmologic exam new patient (92002) + established (92012)
92002 and 92012 cannot be reported together — they're mutually exclusive based on new vs established patient.
Why this pair bundles
Patient is either new or established — not both. Reporting both is a coding error.
Modifier-bypass policy
Modifier indicator: 0 — no modifier bypass is permitted for this pair under any circumstance.
No bypass. Choose one based on patient status (no E&M from this provider's group in past 3 years = new).
Documentation requirements
- Verify patient new/established status before code selection
Common clinical scenarios
- Coding error when re-establishing care after gap
Frequently asked questions
Why does CMS bundle 92002 and 92012?
Patient is either new or established — not both. Reporting both is a coding error.
What documentation supports separate billing?
Verify patient new/established status before code selection.
When does this conflict typically arise?
Coding error when re-establishing care after gap.
Sources
Catch NCCI 92002/92012 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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