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Ophthalmology and Optometry Coding Alert

Reader Question:

92225-92226: Apply Initial EO Code to New Condition

Published on Tue Nov 08, 2011

Question: I'm confused about the extended ophthalmoscopy codes. Is 92225 for a new patient and 92226 for an established patient? Should I bill twice for both eyes? California Subscriber Answer: The extended ophthalmoscopy (EO) codes, 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and 92226 (... subsequent), don't correspond to new and established patients. CPT® does not intend for 92225 to be a one-time-only code, only to be used with new patients. Rather, report 92225 for the initial EO associated with new symptoms of a nonchronic condition for each eye. Example 1: The ophthalmologist sees a patient complaining of flashes and floaters in the right eye. He performs an initial EO (92225-RT), finding post vitreous detachment. He asks the patient to return in six weeks. At that visit, he performs a subsequent EO (92226-RT). A few weeks after that, the patient returns, now [...]
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