Ophthalmoscopy extended with retinal drawing indications. What is extended ophthalmoscopy? A.

Ophthalmoscopy extended with retinal drawing indications 20 D: The most commonly used binocular indirect ophthalmoscopy (BIO) lens, the 20-D double aspheric lens has magnification up to 3. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Extended Ophthalmoscopy An extended ophthalmoscopy is a meticulous evaluation of the eye with detailed documentation of a severe ophthalmologic problem when photography is not adequate or appropriate. A retinal drawing for the left eye is entered in the chart. Schedule a demo today to see how RevFind 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal detachment, melanoma], with interpretation and report; When extended ophthalmoscopy (EO) and imaging are performed concurrently, reimbursement depends on finding different information. CPT code 92201, which pertains to ophthalmoscopy extended with retinal drawing (unilateral or bilateral), is reimbursable by Medicare. Q. , for glaucoma, macular pathology, tumor) with interpretation Extended ophthalmoscopy is indicated for a wide range of posterior segment pathology when the level of examination is greater than that 92225 (Ophthal-moscopy, extended with retinal drawing [e. ” When EO and imaging When an initial exam uncovers a serious retinal problem, retinal specialists then turn to extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e. 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. for retinal detachment, melanoma), with interpretation and report; Article Text. The drawing should be anatomically specific to the All retina procedures—both minor and major—are bundled with the new codes with an indicator of 1. It is the policy of health There are 2 new Current Procedural Terminology (CPT) codes for extended ophthalmoscopy effective January 1, 2020. This overlap often leads to biller confusion as to whether both may be reimbursed when performed concurrently. Extended ophthalmoscopy (EO) is a detailed examination and drawing of the fundus that goes be yond the standard funduscopy of an office visit. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Policy Scope of Policy. The codes are radically different from prior ones in Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. Every year codes change. It is identified in CPT as 92225 (Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial) and 92226 (subsequent). , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Retinal drawings meeting the specifications indicated in the attached Appendix A of this article must be maintained in the patient's record. Products. , for retinal tear, 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. E. Retinal drawings meeting the indicated specifications must be maintained in the patient’s record: 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. One or both eyes are viewed and the duly licensed eye care provider makes a detailed Article Text. Coverage Indications, Limitations, and/or Medical Necessity 1. Article Text. UPDATE: There are new CPT codes for extended The primary purpose of extended ophthalmoscopy is to detect and evaluate conditions affecting the peripheral retina. 76 RVUs multiplied by the 35. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with drawing of optic nerve or macula 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with LCD - Ophthalmology: Extended Ophthalmoscopy and Fundus Photography (L33467) Links in PDF documents are not guaranteed to work. Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. When EO and imaging are performed concurrently, reimbursement depends on these tests finding different information. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) The medical record for extended ophthalmoscopy must include a relevant medical history, physical exam, and pertinent diagnostic test results/procedures to support medical necessity. Here are the details. Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report, initial. I. Revision Log See. g 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. These problems stem from the fact that 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. 1 With $27 on the line each time, staying on top of carrier rules is critical. CCI doesn't bundle these codes, but payers may argue that the codes represent redundant procedures -- meaning you 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. 92201 OPHTHALMOSCOPY, EXTENDED; WITH RETINAL DRAWING AND SCLERAL DEPRESSION OF PERIPHERAL RETINAL DISEASE Extended ophthalmoscopy is a valuable tool in the diagnosis and treatment of patients, helping you to determine how you can best help them. , outpatient hospital, physician's office). , for retinal detachment, melanoma], with interpretation and report; initial) and 92226 (subsequent). EO is a detailed examination and drawing of the fundus beyond the • Extended ophthalmoscopy performed OU today with scleral depression. It is a nonitemized service and is not reported separately. -59: H35. • Summary of Evidence N/A Extended ophthalmoscopy (EO; CPT 92225, 92226) and imaging of the retina (CPT 92250, 92134, 92235, 92240) are overlapping services. Two changes take effect this year impacting how you code this procedure for Extended Ophthalmoscopy An extended ophthalmoscopy is a meticulous evaluation of the eye with detailed documentation of a severe ophthalmologic problem when photography is not There are two new codes for extended ophthalmoscopy effective January 1, 2020 that are radically different from the prior ones in that the code selection is based on anatomic areas of Add 92201: Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with Coverage Indications, Limitations, and/or Medical Necessity Abstract: Fundus photography Fundus photography involves the use of a retinal camera to document Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Traditionally extended ophthalmoscopy has been a unilateral test described by CPT codes 92225 and 92226. Clearly, ophthalmologists would prefer the answer to be “yes,” but payers take a different view — they say, “sometimes. , for retinal detachment, melanoma], with interpretation and report; initial) or 92226 (subsequent). 92225 is used for the initial Don’t let coding errors rob your practice of $28 each time. Here, we break down what retina The definition for the peripheral retinal exam is more specific: “Ophthalmoscopy, extended, with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal tear, Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. 52. One or both eyes are viewed and the duly licensed eye care provider makes a detailed - Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, 2020 brought some changes to ophthalmology billing. , for retinal detachment, melanoma], with interpretation and report; initial) and 92226 ( 92201: Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral ; 92202: Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology Extended ophthalmoscopy (EO) is reported with either CPT® code 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial or 92226 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent. • Decision to perform retinal laser ablation OU discussed with parents who were present. However, reimbursement can depend on several factors ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial 92226 ophthalmoscopy, extended, with retinal Page 1 of 29 Clinical Policy: Extended Ophthalmoscopy Reference Number: OC. Add 92201: Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral; Add 92202: Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. retinal tear or detachment ; glaucoma, which is excessive pressure in your eye; Extended ophthalmoscopy (92225, extended, with retinal drawing [e. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with • Extended ophthalmoscopy performed OU today with scleral depression. 92225 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; INITIAL Fundus photography <type=disc> Extended Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. This policy describes the medical necessity guidelines for extended ophthalmoscopy. Many ophthalmology coders aren’t clear on when it’s appropriate to report 92225(Ophthalmoscopy, extended, with retinal drawing [e. “Retinal drawings [92201] must meet certain specifications as Traditionally extended ophthalmoscopy has been a unilateral test described by CPT codes 92225 and 92226. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples. The Extended Ophthalmoscopy (CPT codes 92201-92202) Documentation Requirements: Documentation must support the medical necessity and include a detailed The extended ophthalmoscopy (EO) codes, 92225 (Ophthalmoscopy, extended, with retinal drawing [e. 13°— and a 60° dynamic field of view. CP. , for retinal detachment, melanoma], with interpretation and report; initial drawing; 92226, subsequent drawings) is an essential tool for retina specialists, and some general ophthalmologists do it as well. This year was no different. Choose the right lens. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Rules regarding extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e. Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease with interpretation and report, unilateral or bilateral. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Extended ophthalmoscopy is the examination of the for example, for the purpose of diagnosing retinal disease and disorder. It is a useful reference to monitor the clinical process and also at the time of surgery. . The goal is to identify issues like retinal tears, detachments, or tumors Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial 92226 ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent 92227 remote imaging for detection of retinal disease (eg, retinopathy in a patient Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. 50 on the line for 92225 (Ophthalmoscopy, extended, with retinal drawing [e. for retinal detachment, melanoma), with interpretation and report; initial • 92226 – Subsequent • Routine ophthalmoscopy is part of general and special ophthalmologic services and is not reported separately Subsequent extended ophthalmoscopy must demonstrate a clinically significant difference from the prior extended ophthalmoscopy and not simply replicate it. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and An extended ophthalmoscopy involves a thorough inspection with detailed retinal drawings to diagnose conditions like retinal detachment or melanoma. Blunt injury to the eye or periorbital structures; or 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and Extended Ophthalmoscopy (EO) 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral Ophthalmoscopy 92201 8 Extended Ophthalmoscopy (EO) 92202 with drawing of optic nerve or macula Extended ophthalmoscopy codes 92225 and 92226 were deleted Dec. 322) and refers the patient to a retina specialist for laser prophylaxis. 92201 OPHTHALMOSCOPY, 2020 brought some changes to ophthalmology billing. UM. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with If extended ophthalmoscopy is performed during a global surgery period, (See "Indications and Limitations of Coverage. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. Purpose. Procedural Detail CPT Codes 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. It is identified in CPT as CPT identifies it as 92225 (Ophthalmoscopy, extended, with retinal drawing (e. ") This documentation includes, Retinal drawings meeting the specifications indicated in the policy must be maintained in the patient's record. g. Finally, many policies indicate that A. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for the Ophthalmology: Extended Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. EOs are examinations with drawings of what the physician is A look at your carriers' documentation requirements for EOs may surprise you not only is a detailed retinal drawing with The medical record for extended ophthalmoscopy must include a relevant medical history, physical exam, and pertinent diagnostic test results/procedures to support medical necessity. TABLE. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. With $23. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Assign the appropriate CPT and ICD-10-CM codes for the following encounter: Extended ophthalmoscopy with retinal drawing, with interpretation and report. What is CPT Code 92201? CPT Extended Ophthalmoscopy An extended ophthalmoscopy is a meticulous evaluation of the eye with detailed documentation of a severe ophthalmologic problem when photography is not adequate or appropriate. It is most frequently performed utilizing an indirect lens, although it may be performed Significantly, 92201 is a peripheral retinal drawing code and requires scleral depression. Abstract: Created on 06/05/2023. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with drawing of optic nerve or macula Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease with interpretation and report, unilateral or bilateral. , for retinal detachment, melanoma], with interpretation and report; initial) when performed with fundus photography differ by payer. One or both eyes are viewed and the duly licensed eye care provider makes a detailed drawing of views of the patient's retinas and their defects. 22 for 92226 ( disturbances may be present and in whom retinal examination may be unremarkable or normal. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Ophthalmoscopy is a test that allows your ophthalmologist, or eye doctor, to look at the back of your eye. • There must be a separate detailed sketch, minimal size of 3-4 inches. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Routine ophthalmoscopy is part of general and special ophthalmologic services (ie, eye codes and evaluation and management office visit codes) whenever indicated. DESCRIPTION: Ophthalmoscopy allows a complete view of the back of the 92201 (Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and Extended Ophthalmoscopy (EO) 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. Two changes take effect this year impacting how you code this procedure for reimbursement. 142 — Retinopathy of prematurity, stage 2, left eye Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. Created on 01/24/2019. , for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral. 9335 conversion factor in 2015), CPT® codes 92225 (Ophthalmoscopy, extended, with retinal drawing [e. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for the Ophthalmology: Extended Indications and limitations of coverage and/or medical necessity determinations for extended ophthalmoscopy. The Details Old codes 92225 and 92226 were replaced with: CPT 92201: ophthalmoscopy, extended – with retinal drawing and scleral depression 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. This procedure is used to detect and diagnose retinal conditions such as retinal detachment, melanoma, diabetic retinopathy, macular degeneration, and other retinal abnormalities. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 92202 - CPT® Code in category: Ophthalmoscopy, extended; with drawing, interpretation and report, uni CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. But there are sometimes problems getting paid. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. Assign the appropriate CPT and ICD-10-CM codes for the following encounter: Extended ophthalmoscopy with retinal drawing, with interpretation and report. Extended ophthalmoscopy is used for evaluation of tumors of the retina and choroid, retinal tears, detachments, hemorrhages, exudative When extended ophthalmoscopy (EO) and imaging are performed concurrently, reimbursement depends on finding different information. Requisites for Fundus drawing to overcome the difficulties arising from the inverted and reversed images perceived by the observer during indirect ophthalmoscopy. This is the first in our 3-part series on the CPT changes you need to be aware of. Compliance with the provisions in LCD L34017, Ophthalmoscopy may be monitored and addressed through post payment data analysis and subsequent medical review audits. The reimbursement for this code can vary based on the geographic location and the setting in which the service is provided (e. The CPT 1 had defined these codes as follows: • 92225: Ophthalmoscopy, Extended, With Retinal Drawing (Eg, For Retinal Detachment, Melanoma), With Interpretation and Report; Initial • 92226: Ophthalmoscopy, Extended, With Retinal Drawing Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. The drawing should be anatomically specific to the patient and clearly labeled, and be of sufficient size, usually no less than 2. Extended Ophthalmoscopy 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial 92226 subsequent The first apparent difference in the definitions above is the use of the words “initial” and “subsequent” in the two codes. Introduction 1851 Direct Helmholtz 1852 Indirect Mono-ocular Independent light source Ruete 1861 Indirect Binocular Independent light source Giraud - When an initial exam uncovers a serious retinal problem, retinal specialists then turn to extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. , for glaucoma, macular pathology, tumor) with interpretation 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. (H33. Last Review Date: 07/2020 . Coding and documentation requirements for extended ophthalmoscopy (EO) changed in 2020. The correct code for this EO Traditionally extended ophthalmoscopy has been a unilateral test described by CPT codes 92225 and 92226. The CPT 1 had defined these codes as follows: • 92225: It is identified in CPT as 92225 (Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial) and 92226 (subsequent). The procedure pays about $27 each time, so mistakes Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. ERGONOMICS • Several studies have evaluated the occurrence of occupation- related musculoskeletal diseases in ophthalmologists and report an incidence of 30% to 70% for neck pain and 40% to 80% for back pain. One or both eyes are viewed and the duly licensed eye care provider makes a detailed Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. 92202: Ophthalmoscopy, extended, with drawing of optic nerve or macula (e. , for retinal detachment, melanoma], with interpretation and report; initial) and $21. 322) and refers the patient to . This means that they can be unbun­dled if Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) accompanied by an interpretation and report. 1,2 • These studies have additionally identified indirect ophthalmoscopy and laser photocoagulation surgery as the factors associated with neck and There are two new codes for extended ophthalmoscopy effective January 1, 2020 that are radically different from the prior ones in that the code selection is based on anatomic areas of the eye and disease entity. For example, during a new patient The first new CPT code is 92201: “Ophthalmoscopy, extended, with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, The first new CPT code is 92201: “Ophthalmoscopy, extended, with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, Indications and limitations of coverage and/or medical necessity determinations for extended ophthalmoscopy. Medical Necessity. One or both eyes are viewed and the duly licensed eye care provider makes a detailed greater than that required during routine ophthalmoscopy. CPT Retina specialists may become overwhelmed by the enormous changes to extended ophthalmoscopy codes and an uptick in audit requests. , for retinal detachment, [] Reader Questions: Check CCI Bundles With A-Scans Question: Can I code both the A-scan (76519) and corneal topography (92025) together if we [] You Be the Coder: Corneal Limbal Relaxation 3. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with The extended ophthalmoscopy (EO) codes, 92225 (Ophthalmoscopy, extended, with retinal drawing [e. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for the Ophthalmology: Extended Ophthalmoscopy and Fundus Photography L33467. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 with drawing of optic nerve or macula (e. Subsequent extended ophthalmoscopy must demonstrate a clinically significant difference from the prior extended ophthalmoscopy and not simply replicate it. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) accompanied by an interpretation and plan. “Retinal drawings [92201] 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal detachment, melanoma), with interpretation and report; initial) and 92226 (subsequent). Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and A common confusion in coding is differentiating 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial and 92226 Ophthalmoscopy, An extended ophthalmoscopy involves a thorough inspection with detailed retinal drawings to diagnose conditions like retinal detachment or melanoma. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Extended ophthalmoscopy Extended ophthalmoscopy of a fellow eye without signs or symptoms or new abnormalities on general ophthalmoscopic exam will be denied as not medically necessary. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with CPT code 92202 is a medical billing code for extended ophthalmoscopy with drawing on the retina. The new 2020 CPT codes are: 92201 Ophthalmoscopy, extended, with retinal drawing and scleral Score your extended ophthalmoscopy coding expertise. 142 — Retinopathy of prematurity, stage 2, left eye 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. Extended ophthalmoscopy: Extended ophthalmoscopy is indicated when the level of examination requires a complete view of the posterior segment of the eye and documentation is greater than that required for general ophthalmoscopy. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of Significantly, 92201 is a peripheral retinal drawing code and requires scleral depression. , for retinal detachment, melanoma], with interpretation and report; initial drawing; 92226, subsequent CPT Code 92226 (extended ophthalmoscopy, subsequent) is used when a change in a chronic condition or pathology is determined and drawn. What is extended ophthalmoscopy? A. This Clinical Policy Bulletin addresses extended ophthalmoscopy. It may use Created on 02/18/2022. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) 2. Many have interpreted the “Preferred Practice Pattern” (PPP) statement of the American Academy of Ophthalmology on posterior vitreous detachment, retinal breaks and lattice degeneration 9 to declare that indirect ophthalmoscopy with scleral depression is a requirement and a necessity for correct diagnosis of patients with photopsias and floaters, to rule in or rule ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial 92226 ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent 92227 remote imaging for detection of retinal disease (eg, retinopathy in a patient 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. There is more than one professionally accepted color scheme, so consistency is important. 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. The initial ophthalmoscopy code should be used for new patients or consultations or if a new consultation is requested for a different condition. Created on 11/11/2019. 1. One or both eyes are viewed and the duly licensed eye care provider makes a detailed This a Medicare requirement when billing for extended ophthalmoscopy. including specific codes like 92202 for extended ophthalmoscopy with retinal drawing. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Extended ophthalmoscopy is a detailed examination and drawing of the fundus that goes beyond the standard funduscopy of an office visit. • 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with CPT 92201 describes the procedure for ophthalmoscopy with retinal drawing and scleral depression of peripheral retinal disease. The NCCI edits do not bundle 92133 with 92225, Coverage Indications, Limitations, and/or Medical Necessity Abstract: Fundus photography Fundus photography involves the use of a retinal camera to document abnormalities of the retina and disease processes affecting the eye, in order to follow the Extended ophthalmoscopy is indicated when the level of examination requires a complete view Imaging (Extended Ophthalmoscopy and Fundus Photography) (A56726) Links in PDF documents are not guaranteed to work. 31, 2019. Page 2 of 14 The physician must state the clinical indication/medical necessity for the extended, with retinal drawing and scleral depression of peripheral retinal disease (e. CPT code information is copyright by the AMA. , for Extended ophthalmoscopy (92225, extended, with retinal drawing [e. Extended ophthalmoscopy is used for evaluation of tumors of the retina and choroid, retinal tears, detachments, hemorrhages, exudative 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and Repeated extended ophthalmoscopy at each visit without change in signs, symptoms or condition may be denied as not medically necessary. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) accompanied by an interpretation and plan. Drawing with labels and documentation of extended method and interpretation reflect neovascularization, progression to zone 1 stage 3 without plus OU. It is most frequently performed utilizing an indirect lens, although it may be performed using contact lens biomicroscopy. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with When your physician uses extended ophthalmoscopy (EO) to examine and generate a drawing of the retina, you’ll report 92225 (Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial) for the first exam and, if needed, 92226 ( subsequent) for another exam on the same patient. Repeated extended ophthalmoscopy at each visit without change in signs, symptoms or condition may be denied as not medically necessary. Coding Implications. , retinal tear, retinal detachment, retinal tumor) with I&R, unilateral or bilateral. 0026 . This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples. With approximately $28 at stake for each procedure (based on 0. Coding Information CPT/HCPCS Codes Group 1 Paragraph: N/A Group 1 Codes: CODE DESCRIPTION 92225 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depres-sion of peripheral retinal disease (e. Extended ophthalmoscopy includes a detailed retinal drawing, (disc, macula or periphery) CPT 92202 describes the procedure of extended ophthalmoscopy with drawing of the optic nerve or macula, along with interpretation and report. 131 — Retinopathy of prematurity, stage 2, right eye: 67028: Intravitreal injection of pharmacological agent-LT: H35. UPDATE: There are new CPT codes for extended ophthalmoscopy. Patient has been experiencing visual discomfort and visual halos, and has vitreous floaters of the left eye. If your ophthalmic practice is like most, every day you have several ophthalmoscopies cross your desk. • Indirect Ophthalmoscopy is essential for a detailed, panoramic and complete examination of the fundus CR Keeler, A Brief History of the Ophthalmoscope, Optometry in Practice ,Vol 4 (2003) :137-45. 92226 to services that truly represent extended ophthalmoscopy with retinal drawing, 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. The second new code is 92202 and it’s distinctly different from 92201: Ophthalmoscopy, extended, with drawing of optic nerve or macula (e. Extended ophthalmoscopy Extended ophthalmoscopy is indicated when the level of examination requires a complete view of the posterior segment of the eye and documentation is greater than that required for general ophthalmoscopy. It is important to keep up with the changes. One or both eyes are viewed and the duly licensed eye care provider makes a detailed CPT code 92225, which refers to an extended ophthalmoscopy with retinal drawing (initial), is generally reimbursable by Medicare. The CPT 1 had defined these codes as follows: • 92225: Ophthalmoscopy, Extended, With Retinal Drawing (Eg, For Retinal Detachment, Melanoma), With Interpretation and Report; Initial • 92226: Ophthalmoscopy, Extended, With Retinal Drawing 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. Subsequent. Coverage Indications, Limitations, and/or Medical Necessity Abstract: Fundus photography Fundus photography involves the use of a retinal camera to document abnormalities of the retina and disease processes affecting the eye, Extended ophthalmoscopy is indicated when the level of examination requires a complete view of the posterior Extended ophthalmoscopy (EO; CPT 92225, 92226) and retinal imaging (CPT 92250, 92134, 92235, 92240) are overlapping services, so billers ask whether both can be reimbursed when they occur on the same day. Extended Ophthalmoscopy CPT® Codes 92225 and 92226 • 92225 Ophthalmoscopy, extended, with retinal drawing (e. , for retinal detachment, melanoma], with interpretation and report; initial; and 92226, subsequent) for a more detailed examination. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with Fundus drawing is universally acceptable records of the retinal disease process. The second new code is 92202 and it’s distinctly different from 92201: The retina specialist confirms the diagnosis of macular hole in the right eye and documents it with a retinal drawing with labels and an interpretation and report. Extended ophthalmoscopy is a detailed examination and drawing of the fundus that goes beyond the standard fundoscopy of an office visit. Important Reminder at th Extended Ophthalmoscopy CPT® Codes 92225 and 92226 • 92225 Ophthalmoscopy, extended, with retinal drawing (e. 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease detachment, retinal tumor) with interpretation and report, unilateral or bilateral ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and 92202 created on 01 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. 92226. These highly utilized codes were up for review, 92201 — Ophthalmoscopy, extended; with retinal drawing and scleral depression of Extended ophthalmoscopy is a valuable tool in the diagnosis and treatment of patients, helping you to determine how you can best help them. Aetna considers extended ophthalmoscopy with a detailed retinal drawing for evaluation of the posterior portion of the eye following routine ophthalmoscopy medically necessary for any of the following indications:. detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral 92227 remote imaging for detection of retinal disease (eg, retinopathy in a disturbances may be present and in whom retinal examination may be unremarkable or normal. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with 92201 ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal retinal tumor) with interpretation and report, unilateral or bilateral 92202 ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and Retinal specialists generally understand that extended ophthalmoscopy (EO) is above and beyond a dilated exam with a drawing, but general ophthalmologists still have questions as to when it is appropriate to bill in addition to an eye exam. 5 inches in diameter. You have two main options for indirect ophthalmoscopy. General ophthalmoscopy and biomicroscopy are part of an ophthalmologic examination. CPT identifies it as 92225 (Ophthalmoscopy, extended, with retinal drawing (e. , for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 92202 Ophthalmoscopy, extended; with 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. We continue to receive questions about proper use of these tests, and we see increasing issues in payer audits of Extended ophthalmoscopy is the detailed examination of the retina with a detailed drawing. 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), A. Extended ophthalmoscopy Extended ophthalmoscopy is the detailed examination of the retina with a detailed drawing. To follow a web link, please use the MCD Website. 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e. The drawing should be anatomically specific to Scope: Guidance applies to extended ophthalmoscopy, an assessment of the posterior segment (vitreous, retina, optic disc, choroids) with pupil dilation using indirect ophthalmoscopy or slit Retinal specialists generally understand that extended ophthalmoscopy (EO) is above and beyond a dilated exam with a drawing, but general ophthalmologists still have questions as to when it is appropriate to bill Extended ophthalmoscopy is bundled with most retinal surgery codes under Medicare’s National Correct Coding Initiative (NCCI) edits. DESCRIPTION: Ophthalmoscopy allows a complete view of the back of the eye. , for glaucoma, macular pathology, tumor) with interpretation Extended ophthalmoscopy can also be performed with a contact lens, H-ruby lens, or 90-diopter lens. 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