Wiki Special Ophthalmologic Services

[DD531816]

Good morning,

I am new to ophthalmology and have questions regarding CPT 92225 and 92226. It seems unclear as to whether or not these services can be billed alone and/or with an eye exam. What documentation needs to be in place for these codes. Any guidance or directions is greatly appreciated. Thanks

Doreen

 

[bungalowgirl]

A drawing of the retinas (each eye) and where any defects (if found) must be done, either in the body of the exam or as a sep. document w/a note in exam to reference the separate signed document.
On another note, our experience has been that some commercial payers will pay for this service as well as the eye exam, and others will not(including gov't), considering the extended ophthalmoscopy to be bundled w/the exam. Definitely submit your eye exam/ov code w/a 25 mod when billing both codes.

 

[DD531816]

Thanks for the help. I am wondering if the 92225 and 92226 can be billed alone as long as the proper documentation, ie drawings and report, are included and signed by the physician? The explanation in the CPT book is confusing.