health insurance claim form ophthalmoscopy2020 brought some changes to ophthalmology billing. This is the first in our 3-part series on the CPT changes you need to be aware of.

UPDATE: There are new CPT codes for extended ophthalmoscopy.

The Details

Old codes 92225 and 92226 were replaced with:

  • CPT 92201: ophthalmoscopy, extended – with retinal drawing and scleral depression of peripheral retinal disease with interpretation and report (i.e. conditions such as retinal tear, detachment, or tumor), unilateral or bilateral.
  • CPT 92202: ophthalmoscopy, with drawing of optic nerve or macula with interpretation and report (i.e. for glaucoma, macular pathology, tumor), unilateral or bilateral.

What It Means for Billing

The new codes separate the difference between examining the retina and the retinal periphery from the posterior pole. These two new codes are considered inherently bilateral, so payment is the same whether one or both eyes have pathology. This is a big change impacting reimbursement.

We can only code once and can’t report them together. Denials will occur if billed bilaterally.

Additionally, per CPT description and upcoming CCI edits, fundus photography (CPT 92250) will NOT be separately billable the same day as CPT 92201 or 92202. The “bundling” of the new codes is similar to not being able to bill fundus photography and CPT 92133 together.

Reimbursement for the new ophthalmoscopy ICD-10 codes will likely be the same as what was covered under the previous codes. However, we won’t know for certain until the insurance companies update their policies.

Billing #ProTip

The new ophthalmoscopy codes don’t need modifiers. Don’t use -RT, -LT or -50. Submit your claim without a modifier.

Coding changes have you puzzled?
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