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92225 question how to code?

Carole Posted Tue 21st of April, 2015 14:33:01 PM

How do I code for bilateral dilated fundus exam by a retinal specialist with retinal drawings?

SuperCoder Answered Wed 22nd of April, 2015 00:36:09 AM

Use 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; initial) accordingly.

Carole Posted Wed 06th of May, 2015 00:51:47 AM

You didn't answer the question, which was, how to code a BILATERAL fundus exam????????????? Medicare rejects 50 modifier with 2 units.

SuperCoder Answered Wed 06th of May, 2015 01:09:35 AM

I am considering Ophthalmoscopy, extended, with retinal drawing, initial examination. Use any of the below mentioned method of billing.
1. CPT code 92225-LT and 92225-RT
2. CPT 92225-50 modifier -1 unit.
3. CPT 92225-50 modifier -1unit and 92225-1 unit. (Use same Dollar value on each claim line in this case).

Fundus exam done with Retinal drawing is billed by CPT 92225/92226.

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