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Old 07-26-2010, 09:28 AM
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Question 92014-25 and 92226

Are these two codes routinely billed together? Also, the usage of the 25 modifier on the 92014, is this necessary? I am trying to figure some office notes out and it seems as if billing these together is redundant?
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Old 07-26-2010, 11:11 AM
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E&M code 92014 is a basic ophthalmology exam and does include ophthalmoscopy. However, 92226 indicates extended ophthalmoscopy with retinal drawings. This is why they can be used together and the modifier 25 is added to 92014. I hope this helps.
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Old 07-29-2010, 12:15 PM
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Quote:
Originally Posted by eclecticme View Post
Are these two codes routinely billed together? Also, the usage of the 25 modifier on the 92014, is this necessary? I am trying to figure some office notes out and it seems as if billing these together is redundant?
Extended ophthalmosopy new (92225) and subsequent (92226) have their own rules. I don't know what state you are in but check your MAC's website to see if they have a LCD for these codes for your state. Some states require a certain size and colors drawing. Others, like mine, do not have any specifics about that.

We don't add 25 to the eye codes or E/M codes. The 25 modifier is usually attached when you have a minor surgical procedure, unless you're doing hospital billing and then it is attached when there are diagnostic tests on the same day too.
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Old 08-03-2010, 07:05 AM
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Quote:
Originally Posted by eclecticme View Post
Are these two codes routinely billed together? Also, the usage of the 25 modifier on the 92014, is this necessary? I am trying to figure some office notes out and it seems as if billing these together is redundant?
-25 is used depending on your icd9 code. should b 2 icd9 codes, one showing something different from the routine.

92226 is used with either LT or RT.

at least thats how its done here in NYC.
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Old 08-03-2010, 07:11 AM
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Originally Posted by luismarin1 View Post
-25 is used depending on your icd9 code. should b 2 icd9 codes, one showing something different from the routine.

92226 is used with either LT or RT.

at least thats how its done here in NYC.
ps

also depends on ins... vision plans and med ins do not follow each others guidelines.

exa:
eyemed does not pay for 92226 w/ routine visit, but u still have to bill it if its done.

med ins pays for 92226 w/ med diag while billing a OV 92004/92014/92002/92012

so in other words. itll only pay out if its medical not routine, IMO.
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