Wiki Cpt 92225/92226

[DD531816]

I have a scenario where there are two drawings for CPT 92225. There are listed as two, with a modifier 76. There is documentation with one drawing for the cornea stencil and one for the fundus drawing. In the listed procedures of the medical record, it only lists one test. Can this test be charged twice in one day if the documentation supports both?

 

[mzkandyd]

Please see my exerpt from the AMA:

Lay Description


Ophthalmoscopy allows a complete view of the back of the eye. After the pupils have been dilated, views of the retina are seen with the indirect ophthalmoscope. The exam is extended. The direct ophthalmoscope allows the highly magnified view of the posterior portion of the retina; an indirect ophthalmoscope gives a broader view that includes the posterior and anterior retina and vitreous. An extended ophthalmoscopy can also be performed with a contact lens, three-mirror lens, or 90-diopter lens. One or both eyes are viewed and the physician sketches views of the patient's retinas and their defects. The initial exam (92225) may be insufficient for diagnosis. The follow-up is reported with 92226.



Coding Tips


The codes for these service do not have specific guidelines regarding the unilateral or bilateral nature of the exam. Dependent upon the payer's specific guidelines some may require modifier 52 in accordance with CPT Assistant guidelines to indicate the procedure was performed on one eye only . Other payers, such as Medicare may require modifier 50 if both eyes are examined. Surgical procedures performed on the posterior segment (codes 67005-67229) include extended ophthalmoscopy when performed intraoperatively or postoperatively on the same date of service and is not reported separately.Extended ophthalmoscopy is not usually performed preoperatively on the same date of service unless an emergency arises.For ophthalmic examination, see 92002-92014. For evaluation and management services, see 99201-99350. For computerized ophthalmic diagnostic screening of the optic nerve or retina, see 92133-92134.~

 

[DD531816]

Thank you for the information. So, 92225/92226 should only be reported once per day with the appropriate modifier, depending on one or two eyes viewed?

 

[mzkandyd]

You would report the code if both eyes were done. If only one was done, you would append 52-modifier to indicate only one eye.