Tuesday, February 11, 2014

Optometric Billing-92225-Ophthalmoscopy Extended w retinal drawing - Initial-Acceptable DX Codes

We have done numerous posts on the 92225 proc code. My main reason for this is because it is highly abused among optometrists and optometric billers and billing staff alike. Therefore, in an effort to continue to provide more clarity on this subject I am publishing a list of acceptable Diagnosis Codes that can be reported to Medicare (and most other insurances) when billing for this procedure. I would like to point out that this list is based on Texas medicare Local Coverage Determinations (LCD's) but it is a good reference point for any state as variations in the rule are minute. If you have any questions about your state, feel free to contact Andrew Roy at 802-253-7201 and we will help you find the EXACT DX codes for your state.

Allowed Reimbursamble Diagnoses Pertaining to 92225
115.02                 Retinitis - Infection by Histoplasma Capsulatum [American histoplasmosis - Darling`s disease]
130.2                   Chorioretinitis Due To Toxoplasmosis
190.5                   Malignant Neoplasm - Retina
190.6                   Malignant Neoplasm - Choroid
224.5                   Benign Neoplasm - Retina  [Retinal Nevus]
224.6                   Benign Neoplasm - Choroid [Choroidal Nevus]
228.03                 Hemangioma of Retina
228.09                 Hemangioma - Other Sites
282.60                 Sickle-cell Disease, Unspecified
282.64                 Sickle-cell/Hb-C Disease With Crisis
282.68                 Other Sickle-cell Disease Without Crisis
360.01                 Endophthalmitis - Acute
360.21                 Progressive High (degenerative) Myopia - Malignant myopia
361.00                 Retinal Detachment - Defect - Unspecified
361.01                 Retinal Detachment - Recent - Partial - One Defect
361.02                 Retinal Detachment - Recent - Partial - Multiple Defect
361.03                 Retinal Detachment - Recent - Partial - Giant Tear
361.04                 Retinal Detachment - Recent - Partial - Dialysis
361.05                 Retinal Detachment - Recent - Total or Sub-total
361.06                 Retinal Detachment - Old - Partial
361.07                 Retinal Detachment - Old - Total or Sub-total
361.10                 Retinoschisis - Unspecified
361.11                 Retinoschisis - Flat
361.12                 Retinoschisis - Bullous
361.13                 Retinal Cysts - Primary
361.14                 Retinal Cysts - Secondary
361.19                 Other Retinoschisis And Retinal Cysts
361.2                   Retinal Detachment Serous - without retinal defect
361.30                 Retinal Defect - Unspecified w/o Detachment
361.31                 Retinal Hole w/o Detachment
361.32                 Retinal Tear w/o Detachment
361.33                 Retina - Multiple Defects w/o Detachment
361.81                 Retinal Detachment - Tractional
362.01                 Background Diabetic Retinopathy
362.02                 Proliferative Diabetic Retinopathy
362.03                 Nonproliferative Diabetic Retinopathy
362.04                 Mild Nonproliferative Diabetic Retinopathy
362.05                 Moderate Nonproliferative Diabetic Retinopathy
362.06                 Severe Nonproliferative Diabetic Retinopathy
362.07                 Diabetic Macular Edema
362.10                 Background Retinopathy - Unspecified
362.12                 Retinopathy - Exudative - Coats` syndrome
362.13                 Changes In Vascular Appearance of Retina - Vascular sheathing of retina
362.14                 Retinal Microaneurysms - NOS
362.15                 Retinal Telangiectasia
362.16                 Retinal Neovascularization - NOS
362.21                 Retrolental Fibroplasia [Cicatricial retinopathy of prematurity]
362.31                 Central Retinal Artery Occlusion
362.32                 Arterial Branch Occlusion
362.35                 Central Retinal Vein Occlusion
362.36                 Venous Tributary (Branch) Occlusion of Retina - BVRO
362.41                 Retinopathy - Central Serous
362.42                 Serous Detachment of Retinal Pigment Epithelium [Exudative detachment]
362.43                 Hemorrhage Detachment of Retinal Pigment Epithelium
362.52                 Macular Degeneration - Exudative Senile (WET) [Kuhnt-Junius degeneration]
362.53                 Macular Degeneration - Cystoid
362.54                 Macular Cyst or Hole or Pseudo-hole of Retina
362.56                 Macular Puckering [Preretinal Fibrosis, Epiretinal membrane]
362.63                 Lattice Degeneration of Retina [Palisade degeneration of retina]
362.74                 Pigmentary Retinal Dystrophy [Retinitis Pigmentosa, Albipunctate]
362.81                 Retinal Hemorrhage
362.83                 Retinal Edema [Cotton Wool Spots, Macular, Peripheral, Localized]
362.84                 Retinal Ischemia
363.00                 Focal Chorioretinitis - Unspecified
363.01                 Focal Choroiditis and Chorioretinitis - Juxtapapillary
363.03                 Focal Choroiditis and Chorioretinitis of Other Posterior Pole
363.04                 Focal Choroiditis and Chorioretinitis - Peripheral
363.05                 Focal Retinitis and Retinochoroiditis - Juxtapapillary [Neuroretinitis]
363.06                 Focal Retinitis and Retinochoroiditis - Macular or Paramacular
363.07                 Focal Retinitis And Retinochoroiditis of other Posterior Pole
363.08                 Focal Retinitis And Retinochoroiditis - Peripheral
363.10                 Disseminated Chorioretinitis - Posterior
363.11                 Disseminated Chorioretinitis - Unspecified
363.12                 Disseminated Chorioretinitis - Peripheral
363.13                 Disseminated Chorioretinitis - Generalized
363.14                 Disseminated Retinitis and Retinochoroiditis - Metastatic
363.15                 Disseminated Retinitis and Retinochoroiditis - Pigment Epitheliopathy [Acute posterior multifocal placoid]
363.20                 Chorioretinitis - Unspecified [Choroiditis NOS, Retinitis NOS, Uveitis posterior NOS]
363.21                 Pars Planitis [Posterior cyclitis]
363.22                 Harada`s Disease
363.30                 Chorioretinal Scar - Unspecified
363.70                 Choroidal Detachment [Commotio Retinae, Choroidal Hemorrhage]
363.71                 Choroidal Detachment - Serous [Commotio Retinae, Choroidal Hemorrhage]
363.72                 Choroidal Detachment - Hemorrhagic [Commotio Retinae, Choroidal Hemorrhage]
365.10                 Open-angle Glaucoma Unspecified [Wide-angle Glaucoma NOS]
365.11                 Primary Open Angle Glaucoma [Chronic, Simple, Noncongestive, Nonobstructive]
365.12                 Low Tension Open-angle Glaucoma
365.13                 Pigmentary Open-angle Glaucoma
365.14                 Glaucoma of Childhood [Infantile, Juvenile Glaucoma]
365.20                 Primary Angle-closure Glaucoma Unspecified
365.21                 Intermittent Angle-closure Glaucoma [Interval, Sub-acute]
365.22                 Acute Angle-closure Glaucoma [Attack, Crisis]
365.23                 Chronic Angle-closure Glaucoma
365.24                 Residual Stage of Angle-closure Glaucoma
365.31                 Corticosteroid-induced Glaucoma Glaucomatous Stage
365.32                 Corticosteroid-induced Glaucoma Residual Stage
365.42                 Glaucoma Associated With Anomalies of Iris [Anomalies NEC, Atrophy, Essential]
365.44                 Glaucoma Associated With Systemic Syndromes
365.62                 Glaucoma Associated With Ocular Inflammations
365.63                 Glaucoma With Vascular Disorders of Eye
365.65                 Glaucoma Associated With Ocular Trauma
368.15                 Other Visual Distortions and Entoptic Phenomena [Refractive: diplopia; polyopia; Photopsia; Visual halos]
379.21                 Vitreous Degeneration [Vitreous cavitation, detachment, liquefaction]
379.23                 Vitreous Hemorrhage
379.24                 Other Vitreous Opacities [Vitreous Floaters, Vitreous Syneresis]
379.26                 Vitreous Prolapse
379.29                 Other Disorders of Vitreous
379.34                 Dislocation - Posterior Lens
871.5                   Penetration of Eyeball with Magnetic Foreign Body
871.6                   Penetration of Eyeball with Nonmagnetic Foreign Body
996.53                 Mechanical Complication Due To Ocular Lens Prosthesis
E931.4                Antimalarials/Drugs Acting On Other Blood Protozoa Causing Adverse Effects In Theraputic Use
V58.69                Long-Term (current) Use of Other Medications

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