Ophthalmology and Optometry Coding Alert

Question: Our physician performed needle oculoelectromyography bilaterally and we reported 92265-50 (Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report; Bilateral procedure). We did not receive bilateral payment. Should we appeal?

Codify Subscriber

Answer: No. In this case, the insurer paid you accurately. Because the descriptor for 92265 says "one or both eyes" and "one or more extraocular muscles," this code includes the service on multiple muscles and both eyes. Therefore, it would be inappropriate to append modifier 50 or to report multiple units even if the physician tests both eyes or several muscles.