Ophthalmology and Optometry Coding Alert

Question: Can I bill 92225 and 92250 at the same visit for a patient with retinal problems? Should I use a modifier?

Indiana Subscriber

Answer: Carriers have different rules regarding extended ophthalmoscopy (92225, ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and fundus photography (92250, fundus photography with interpretation and report). While not bundled in CCI, these two codes represent potentially redundant procedures.
 
No modifier is needed to bill 92225 or 92250 with an eye exam (92004).
 
For extended ophthalmoscopy, the ophthalmologist views the posterior segment of the eye and completes a drawing, which is more or less detailed (the carrier determines the extent of detail required). A fundus photograph is just a photograph of what the ophthalmologist sees when he looks at the eye through the ophthalmoscope.
 
However, fundus photography cannot show the periphery of the posterior segment, just the fundus. Extended ophthalmoscopy, when performed with scleral depression, can show the periphery. Extended ophthalmoscopy gives a better view of holes and tears in the periphery, while fundus photography just documents the vasculature in the fundus area.
 
Logically, the carriers that require more detail for extended ophthalmoscopy should be the ones that do not allow payment for fundus photography on the same day.
 
Administar of Indiana, in a May 15 revision to its LMRP on extended ophthalmoscopy, says it is "not medically necessary" to perform fundus photography, fluorescein angiography (92235, fluorescein angiography [includes multiframe imaging] with interpretation and report), or indocyanine-green angiography (92240,  indocyanine-green angiography [includes multiframe imaging] with interpretation and report) on the same day as extended ophthalmoscopy.