Optometry Coding & Billing Alert

Question: If a patient reports flashes and floaters and we do not find evidence of retinal pathology on routine ophthalmoscopy, are we justified in billing for extended ophthalmoscopy (EO)?

Kansas Subscriber

Answer: If the ophthalmoscopy is a routine part of an eye exam, do not bill for it separately. However, complaints of flashers and floaters are always serious and must be evaluated carefully; often, these symptoms justify extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial).

Use 92225 to report a Goldmann-3 exam (examining the retina with a three-mirror goniolens). Remember to keep your interpretation and report of the findings in the patient's medical record.

In many cases in which flashers and floaters are present, extended ophthalmoscopy (EO) combined with a retinal exam shows vitreous degeneration or posterior vitreous detachment (379.21, Vitreous degeneration). If an optometrist does not see anything in the routine ophthalmoscopy, he will probably not do an EO.

In the unlikely event that you don't find any significant problems with the retina after the EO, link 92225 to 379.24 (Disorders of vitreous body; other vitreous opacities). "Vitreous floaters" appears in a note under that code in the ICD-9 manual. If  you do not see floaters, look to the 368.1x series (Subjective visual disturbances).

However: If you can't see anything more with an EO than you can see with a routine ophthalmoscopy, it may be hard to defend the use of the EO. Some experts recommend not billing for an EO unless you have some abnormality of the retina or vitreous to draw in the report