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Extended Ophthalmoscopy 92201/92202 coding

S

seetha

Contributor
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Location
Hyderabad, Telangana
I have a little confusion about ICD tagging for extended Opthalmoscopy CPTs 92201 and 92202. What ICDs cover for 92201 and what ICDs cover for 92202.
 
You can find the list of approved ICD codes in the LCD for these codes at the First Coast Services website. It mirrors the NCD from CMS.

I will tell you that these codes, if used too often, may make it more likely that you would be audited and should be used very rarely. It's very important that, when the doctor does these procedures, the guidelines in the CPT description be followed closely.

As a point of information, I asked a very busy retinal specialist how often he bills these codes during the course of a year and he said less than 5 times per year. In reality, retinal photos and OCT scans provide much more useful information that the drawing required for these codes.

Tom Cheezum, OD, CPC, COPC
 
for 92201 CPT discretion saying need scleral depression. but we have never observed that word in the Ophthalmology medical records. When we saw Retinal abnormality like BDR, PDR and other retinal conditions, we are coding 92201. LCD gave the list of ICDs but didn't differentiate for 92201 and 92202. but doctor is saying most of the time i am doing 92202 but you are coding 92201 why?
 
I'm going to try to decipher what you've said here. Under the definitions, the 92201 is only to be used for peripheral retinal disease and does require scleral depression and the 92202 is for the optic nerve head and macular areas. The Interpretation and Report for the 99201 should actually mention that scleral depression was done. If it doesn't, then you haven't met the criteria to bill the code. I'll refer to that old record keeping saying I was taught as a student: "If you didn't write it down, you didn't do it."

IMHO, if you are coding the 92201 or 92202 just because you have a patient with BDR or PDR etc, that's incorrect and doesn't qualify for billing extended ophthalmoscopy. Frankly, it sounds like the doctor is just billing that to add to the bill. (Sorry if that sounds harsh, but that's what it sounds like) Noting those things is just part of regular ophthalmoscopy. (I'll refer to my retinal specialist friend who only bills the code 5 times per year)

You also have to look at these codes from another standpoint. Is a simple, often fairly rudimentary, drawing going to provide you with the same level of detail and diagnostic information as a retinal photo or OCT? CMS guidelines say a test should only be done if it will provide you with information to help with the diagnosis and treatment of a patient. With today's technology, extended ophthalmoscopy is becoming less relevant and useful IMHO.
 
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