lindsey.motter
Networker
Are these two codes routinely billed together? Also, the usage of the 25 modifier on the 92014, is this necessary? I am trying to figure some office notes out and it seems as if billing these together is redundant?
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Wiki 92014-25 and 92226
- Thread starter lindsey.motter
- Start date
sthibo
Guest
E&M code 92014 is a basic ophthalmology exam and does include ophthalmoscopy. However, 92226 indicates extended ophthalmoscopy with retinal drawings. This is why they can be used together and the modifier 25 is added to 92014. I hope this helps.
Last edited:
vpcats
Guest
Extended ophthalmosopy new (92225) and subsequent (92226) have their own rules. I don't know what state you are in but check your MAC's website to see if they have a LCD for these codes for your state. Some states require a certain size and colors drawing. Others, like mine, do not have any specifics about that.
We don't add 25 to the eye codes or E/M codes. The 25 modifier is usually attached when you have a minor surgical procedure, unless you're doing hospital billing and then it is attached when there are diagnostic tests on the same day too.
luismarin1
Guest
-25 is used depending on your icd9 code. should b 2 icd9 codes, one showing something different from the routine.
92226 is used with either LT or RT.
at least thats how its done here in NYC.
luismarin1
Guest
ps
also depends on ins... vision plans and med ins do not follow each others guidelines.
exa:
eyemed does not pay for 92226 w/ routine visit, but u still have to bill it if its done.
med ins pays for 92226 w/ med diag while billing a OV 92004/92014/92002/92012
so in other words. itll only pay out if its medical not routine, IMO.