Ophthalmology and Optometry Coding Alert

Fast Facts About 92225-92226

Published on Sun Feb 24, 2008

The extended ophthalmoscopy (EO) codes, 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and 92226 (... subsequent), don't necessarily correspond to new and established patients. CPT does not intend for 92225 to be a one-time-only code to be used exclusively with new patients. Rather, report 92225 for the initial EO associated with new symptoms of a nonchronic condition.

2008 National Medicare Physician Fee Schedule Allowable: $23.50 for 92225 (total RVUs = 0.62) when performed in the office, $21.22 for 92226 (total RVUs = 0.56) when performed in the office.

Global period: XXX. The classification XXX (Global surgical rules do not apply) means the service is truly free of global surgical bundling issues. Therefore, you can separately report 92225 and 92226 and services such as E/M visits on the same date.

Sample covered diagnosis codes include (note that this is not a complete list):

• 190.5 -- Malignant neoplasm of retina

• 224.5 -- Benign neoplasm of retina

• 360.60 -- Foreign body, intraocular, unspecified

• 361.2 -- Serous retinal detachment

• 362.07 -- Diabetic macular edema

• 365.04 -- Ocular hypertension

• 365.10 -- Open-angle glaucoma, unspecified

• 365.11 -- Primary open-angle glaucoma

• 365.14 -- Glaucoma of childhood

• 365.15 -- Residual stage of open-angle glaucoma

• 365.20 -- Primary angle-closure glaucoma, unspecified