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Opthalmoscope coding initial/subsequent and bilateral concerns.

Donna Posted Thu 18th of June, 2015 15:56:46 PM

Hello,
When (92225) Extended Ophthalmoscopy,Initial is done bilaterally, I interpret non-Medicare payers to want x1 unit and it should be
one line item with -50 to indicate bilaterally done—and one disease entity in both eyes. Do you add CPT(92225)again (x2) with each disease entity and time spent for each disease examination?

What if a Medicare payer, do you use (92225) x1 on two lines, with LT/RT descriptors per (1) disease type.

I hoping to clarify guidelines and rules for Ophthalmoscope coding and payer rules for submission.

Thank you for any insight you can give me.

SuperCoder Answered Fri 19th of June, 2015 00:57:18 AM

You can bill CPT 92225/92226 as follows:
1. Bill CPT 92225-RT and 92225-LT on different lines.
2. Bill CPT 92225 and 92225 on different lines, both 1 unit and equal dollar amount.
3. Bill 92225 with 50 modifier X1 unit and total amount for bilateral procedure.
4. Bill 92225-50 modifier X1 unit and single eye dollar amount and on 2nd line bill 92225 X1 unit with single eye dollar amount.

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