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Thread: 92014-25 and 92226

  1. #1
    Join Date
    Apr 2007
    Location
    Harrisburg, PA
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    11

    Question 92014-25 and 92226

    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?

  2. #2
    Join Date
    Apr 2007
    Location
    Houma, La.
    Posts
    35

    Smile

    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 by sthibo; 07-26-2010 at 12:12 PM. Reason: none done

    Sally Thibodeaux CCS,CPC,LPN
    Houma,La. Chapter

  3. #3

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    Quote Originally Posted by eclecticme View Post
    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?
    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.

  4. #4
    Join Date
    Apr 2007
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    Nassau Central New York Chapter
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    51

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    Quote Originally Posted by eclecticme View Post
    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?
    -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.

  5. #5
    Join Date
    Apr 2007
    Location
    Nassau Central New York Chapter
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    Quote Originally Posted by luismarin1 View Post
    -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.
    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.

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