Question: Ohio Subscriber Answer: Consult your insurer's policy for diagnosis codes that support medical necessity. Always code diagnoses based on the MD's documentation. The range of accepted codes is pretty wide. For instance, insurers may accept 362.83 (Retinal edema) and 377.00 (Papilledema, unspecified) to prove medical necessity for an EO. For the initial ophthalmoscopy performed on both eyes, report 92225"RT and 92225-LT. Alternatively, you may report the service once and append modifier 50 (92225-50). If a subsequent drawing is needed on a different date of service, you would report 92226-50 on one line or on separate lines with RT/LT. Some insurers may follow Medicare's requirement of reporting the code once appended with modifier 50 (Bilateral procedure). Other payers may want the code reported twice with modifier 50 appended to the second line, while others may want modifiers LT (Left side) and RT (Right side) on separate lines. Although your inquiry deals with newborns who are not on Medicare, you may want to highlight Medicare's payment and documentation policies for 92225 and 92226. The 2009 Medicare Physician Fee Schedule does not apply a bilateral procedure payment adjustment to these codes. Documentation policies may require a specific size of the drawing using different colors, and most policies require a detailed drawing. Additionally, a legible narrative report of findings is required.