Ophthalmology and Optometry Coding Alert

Score your extended ophthalmoscopy coding expertiseIf your ophthalmic practice is like most, every day you have several ophthalmoscopies cross your desk. With $23.50 on the line for 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and $21.22 for 92226 (... subsequent), based on the 2008 National Medicare Physician Fee Schedule Allowables, coding mistakes can add up quickly. Are you sure you're coding each extended ophthalmoscopy (EO) correctly?Note: You can find many of the answers to these questions in "Go Beyond Routine Coding for Extended Ophthalmoscopies" and "Fast Facts About 92225-92226," in Ophthalmology Coding Alert Vol. 11, No. 3.Question 1You may not report an ophthalmoscopy separately when the ophthalmologist has also performed a general ophthalmic examination (92002-92014) on the same day. True or false?Answer: False. Although any general ophthalmic exam will include a routine ophthalmoscopy (which can include a slit lamp exam with a Hruby lens or direct ophthalmoscopy for fundus examination), you may be able to report extended ophthalmoscopy if the ophthalmologist has documented medical necessity.Documentation should include a detailed and labeled retinal drawing along with an interpretation and report. Some carriers also require a specific size and use of four-six standard colors to label the retinal drawing. Also, be sure to provide the reason the ophthalmologist performed the EO as well as the procedure he used.Question 2The ophthalmologist sees a new patient complaining of flashes and floaters. He performs an initial EO, finding post-vitreous detachment. He asks the patient to return in six weeks. At that visit, he performs a subsequent EO. A few weeks after that, the patient returns, now complaining of blurred vision. The ophthalmologist performs another EO. How should you code for the three EOs?A: 92225 for all three EOsB: 92226 for all three EOsC: 92225 for the first EO, 92226 for the second and thirdD: 92225 for the first EO, 92226 for the second, and 92225 for the thirdE: None of the above.Answer: D. Report 92225 for the initial EO and 92226 for the follow-up EO the ophthalmologist performed after six weeks. Code 92226 is appropriate because the ophthalmologist is following up on the post-vitreous attachment. When the patient returns with the blurred vision complaint, the ophthalmologist is then investigating a new condition, so report 92225.On the other hand, payers consider 92226 to be a "physician service" and not a "diagnostic service." If you report this service in the post-op period for a related diagnosis, some payers may not reimburse for it.If you report the service during the post-op period for an unrelated diagnosis, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to the code, and link to the new [...]