Ophthalmology and Optometry Coding Alert

Question: I just got a denial on 92226. I think I might be using this code incorrectly. Can you explain what it's for and when I can code it? Missouri Subscriber Answer:  Your ophthalmologist likely performs some form of ophthalmoscopy during any general exam. But you should use 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and 92226 ( ... subsequent) to report the service only when the provider does an extended ophthalmoscopy (EO). Key: Your provider is responsible for documenting the encounter and proving that an EO is medically necessary and reimbursable. A reimbursable EO is one that generates information the ophthalmologist could not have attained through other means (such as a view of the peripheral retina obtained by scleral depression versus indentation), experts say. The physician must document the need to perform an EO as most exams include a routine [...]