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Ophthalmology and Optometry Coding Alert

Reader Question:

Ophthalmoscopy

Published on Mon Dec 24, 2012

Question: How should I bill for extended ophthalmoscopy (92225-92226)? Is one code for a new patient and the other for an established patient? Should I bill twice for both eyes?
California Subscriber   Answer: Unless your Medicare carrier has a local medical review policy (LMRP) that says you can bill 92225 only one time, these codes refer to "initial" and "subsequent," not "new" and "established." The CPT principle behind this language comes from hospital coding: When a recurrence of a condition requires hospitalization, the initial hospital visit code may be used again for the new admission. Per CPT, 92225 is not intended to be a one-time-only code. Use 92225 for the initial extended ophthalmoscopy (EO) of new symptoms of a nonchronic condition, such as new flashes and floaters.   Scenario: Flashes and floaters. You see a patient for a complaint of flashes and floaters, and perform an initial [...]
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