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Ophthalmology and Optometry Coding Alert

Reader Question:

Ophthalmoscopy

Published on Wed Nov 01, 2000

Question: What is the difference between routine and extended ophthalmoscopy? Is routine ophthalmoscopy already included in a comprehensive exam?

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Answer: A routine ophthalmoscopy is a service component of intermediate and comprehensive ophthalmological services (92002, 92004, 92012, 92014) per the instructional notes under the ophthalmoscopy section in the current CPT manual. A routine ophthalmoscopy is one that is performed without a justifying sign, symptom or known condition (e.g., dilating and performing an indirect examination as part of a comprehensive visit even though there is no reason to believe that patient may have a problem in the posterior pole).

An extended ophthalmoscopy is code 92225, which includes a retinal drawing with interpretation and report, for the initial extended ophthalmoscopy and code 92226 for a subsequent extended ophthalmoscopy. This service is separately billable when there is a reported sign or symptom or a known diagnostic condition that would make the service reasonable and necessary. Many carriers have specific requirements for the drawing, such as the number of colors to be used.
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