Ophthalmology and Optometry Coding Alert

Know what qualifies as an EO before adding 92225-92226 to another claimMost ophthalmology exams include some form of ophthalmoscopy, and many coders report them almost daily. So how do you know when the exam warrants an extended ophthalmoscopy (EO) code?You'll have to rely on your physician's detailed documentation to prove medical necessity and capitalize on the more complicated service. Read on to make sure you're not missing out on $2 per exam, which can add up fast.Step 1: Know When to Take Coding to the Next LevelAny general ophthalmic examination will include a routine ophthalmoscopy, says Sara Root, CPC, coder for the Fletcher Allen Health Care department of ophthalmology in Burlington, Vt. "An extended ophthalmoscopy is a special ophthalmologic service that goes beyond the general eye exam," she says.Caution: The general ophthalmic examination codes (92002-92014) already include the routine ophthalmoscopy, so you should not report routine ophthalmoscopy (which can include a slit lamp examination with a Hruby lens or direct ophthalmoscopy for fundus examination) separately with 92002-92014.When an initial exam uncovers a serious retinal problem, retinal specialists then turn to extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing, with interpretation and report; initial; and 92226, ... subsequent) for a more detailed examination. If you're going to code an extended ophthalmoscopy, the ophthalmologist must provide a retinal drawing and interpretation and report, Root says. The documentation should include the reason the ophthalmologist performed an extended exam as well as the procedure he used."If a coder ever has a doubt as to what was actually performed, he or she should consult the physician," Root says. "Re-education may need to be provided so that the physician is properly documenting the extended ophthalmoscopy."When warranted: If the ophthalmologist's documentation justifies reporting an extended ophthalmoscopy code, you have only two codes to choose from. For an initial extended ophthalmoscopy exam use 92225, and for all subsequent exams use 92226. The initial extended ophthalmoscopy exam may not be sufficient to diagnosis a problem, and a subsequent exam may be necessary. You can report one extended ophthalmoscopy per exam based on the physician's documentation, says Katie Stillman, coding specialist for EYE Q Vision in Fresno, Calif.Step 2: Bill Bilaterally Based on CarrierAlthough you're unable to report most of the other ophthalmic testing codes in the 92xxx series bilaterally, you can report 92225 and 92226 for each eye -- if your ophthalmologist provides medical necessity.Prove it: Carriers will not pay double for bilateral extended ophthalmoscopies unless you can justify medical necessity for performing the exam on both eyes. Don't assume both eyes have the same diagnosis. You must report the correct ICD-9 code(s) with supporting documentation in the medical record to show medical necessity for each eye when performing [...]