Most of the eye exams that your ophthalmologist performs include some form of ophthalmoscopy, but payers often bundle this service into general ophthalmic exam, or E/M codes. So which exam warrants an EO code and deserves extra payment? Detailed documentation is your key to proving medical necessity and capitalizing on the more complicated service.
Read on to make sure you’re not missing out on EOs you could rightfully report.
When Should You Take Coding to the Next Level?
Difference: Any general ophthalmic examination will include a routine ophthalmoscopy. But an extended ophthalmoscopy is a special ophthalmologic service that goes beyond the general eye exam.
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Caution: The general ophthalmic examination codes (92002-92014) already include the routine ophthalmoscopy, so you should not report routine ophthalmoscopy (which can include a slit lamp examination with a Hruby lens or direct ophthalmoscopy for fundus examination) separately with 92002-92014.
When an initial exam uncovers a serious retinal problem, retinal specialists then turn to extended ophthalmoscopy (92225,Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial; and 92226, … subsequent) for a more detailed examination.
Consider this example: An obese female patient presents with headaches, slightly reduced vision in her right eye, vague complaints of soreness and variable blur. A routine ophthalmoscopy shows an elevated disc, so the ophthalmologist decides to perform EO with a Volk 78 lens (although the definition of EO does not refer to any particular type of lens, notes David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas). The EO reveals...
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