Wiki Extended Ophthalmoscopy 92201/92202

[lawl.shan@gmail.com]

Hi everyone!
Our retina doctors are wanting to start including these diagnosistic services with their billing, however I am having a hard time find any resources on these codes. They are wanting to use these to help decongest our OCT machine, as we only have one in our clinic and these doctors see over 50 patients a day, depending on their day sometimes 80.
We are in Noridian Jurisdiction F for Medicare and there are no LCD's that I can find, just a NCD.
Questions our doctors are asking:

1) Is there a limit to how often we are billing these codes? (I don't see that there is, as long as it is medically necessary and can show pathology)
2) Will using these trigger an audit from your experience?
3) What are your retina doctors doing?

If you could include resources that might be helpful, that would be amazing!!!

 

[Cheezum51]

The utilization guidelines in the NCD list the information on allowed frequency. Most are determined by the diagnosis and other treatments. For example, for patients receiving intravitreal injections, they can have up to 12 XOs per year.

Just a point from the standpoint of someone who has seen how a busy retina practice functions. If you have only 1 OCT unit and your doctors are seeing up to 80 patients per day, you need to have at least one or two more OCTs for your clinic. They would be paid for within a few months.

There is no way a drawing is going to truly show the extent of disease as well as an OCT in terms of comparison from one visit to another, especially for macular disease. Also, why would your doctors want to sit there and do drawings most of the day. IMHO, that's a waste of their time with that busy schedule. I've seen the records for a retinal surgeon in my area who doesn't have an OCT and only does drawings. From an auditor's standpoint, they would be considered useless.

Tom Cheezum, OD, CPC, COPC

 

[kteabilling@gmail.com]

The utilization guidelines in the NCD list the information on allowed frequency. Most are determined by the diagnosis and other treatments. For example, for patients receiving intravitreal injections, they can have up to 12 XOs per year.

Just a point from the standpoint of someone who has seen how a busy retina practice functions. If you have only 1 OCT unit and your doctors are seeing up to 80 patients per day, you need to have at least one or two more OCTs for your clinic. They would be paid for within a few months.

There is no way a drawing is going to truly show the extent of disease as well as an OCT in terms of comparison from one visit to another, especially for macular disease. Also, why would your doctors want to sit there and do drawings most of the day. IMHO, that's a waste of their time with that busy schedule. I've seen the records for a retinal surgeon in my area who doesn't have an OCT and only does drawings. From an auditor's standpoint, they would be considered useless.

Tom Cheezum, OD, CPC, COPC

I work for a ophthalmologist who also has a subspecialty of retina. He wants to start using code 92202. Can this code be billed with 92014 or 92012? He does not use E/M codes.

 

[Edmundo]

I work for a ophthalmologist who also has a subspecialty of retina. He wants to start using code 92202. Can this code be billed with 92014 or 92012? He does not use E/M codes.

Hello,

Yes, you can report 92202 alongside eye examination codes. If you need resources for educating physicians on incorporating E/M codes, feel free to reach out. They may be missing potential revenue by not utilizing both sets of family codes. I'm currently working on the 2025 National Average MPFS, but you can see below how the revenue differs.




Thanks,

Edmundo Gonzalez, CPC, CRCR, COPC, OCS