Optometric Billing-the 92225 Procedure Code-UPDATED 01/10/2014

*UPDATED 01/10/2014*

Attention Optometrists and Optometric Billers:


When using 92225 you must be making diagrams. The official definition as reported by the AMA is: Ophthalmoscopy, extended, with retinal drawing.

***UPDATED INFO: Enhanced Definition- "Extended ophthalmoscopy is the illuminated and magnified vascular and nerve examination of the fundus.  It includes the optic disk, retinal vessels, macula and retina.  It may be a dilated procedure.  Always includes a detailed drawing of the retina."-EyeCOR by NTeon

This means that unless there is retinal involvement you should not use this code. You MUST also make your drawings and enter them into the patient's file whenever using 92225. This code is heavily abused by the optometric community and such is the reason I am writing about it today.

This code is also not appropriate to use for dilations as there is no official procedure code for a dilation.

I hope this is helpful to all who read.

Please visit our optometric billing website by clicking here. We will be more than happy to speak with you regarding any questions you may have.

Insurance Companies and the 92135 Procedure Code

Originally, payers only paid the 92135, which was computerized ophthalmic diagnostic imaging of the posterior segment which included an interpretation of the results and a report of the physicians findings (these would be inserted into the patient's medical chart).

However, the new codes allow for the physician to bill the payer more specifically, as there is more to be scanned than just the posterior (back) section of the eye. Specifically, the new codes relate in the following manner:

92132-Front of the eye only, anterior, behind the retina; may now be either unilateral or bi-lateral
92133-Optic nerve, posterior segment of the of the eye.may now be either unilateral or bi-lateral, This would most likely be my choice for a direct replacement of 92135.
92134-Retina, posterior segment of the retina,may now be either unilateral or bi-lateral

The question you have to ask yourself and your staff is, "Does our GDX equipment scan all three sections or just one?" If it only scans one, which I am assuming it does not, then the code will most likey be 92133. If the machine scans all three sections then, the coding will be based on which section of the eye the patient has scanned.

The DX codes below are the codes that are used by Medicare to determine whether or not the patient qualifies for coverage of an OCT (GDX) scan. These codes applied to the 92135 and it is my ASSUMPTION that the codes would GENERALLY apply to the new PROC codes as well.

ICD-9 DIAGNOSIS CODE DESCRIPTION
115.02 Histoplasma capsulatum retinitis
190.6 Malignant neoplasm of eye, choroid
224.6 Benign neoplasm of choroid
228.03 Hemangioma of retina
361.00-361.04 Retinal detachments
361.05-361.07 Recent detachment, total or subtotal
361.10-361.19 Retinoschisis, unspecified
361.2 Serous retinal detachment
361.30-361.33 Retinal defect, unspecified
361.81 Traction detachment of retina
361.9 Unspecified retinal detachment
362.01-362.29 Retinopathy
362.30-362.37 Retinal vascular occlusion
362.40-362.43 Retinal layer separation
362.50-362.56 Macular degeneration
362.60 Peripheral retinal degeneration, unspecified
362.66-362.85 Retinal disorders
363.00-363.08 Chorioretinal inflammations
363.10-363.15 Disseminated chorioretinitis/retinochoroiditis
363.20-363.22 Chorioretinitis, other
363.30-363.65 Chorioretinal scars
363.40-363.43 Choroidal degenerations
363.62-363.72 Choroidal hemorrhage and rupture
363.70-363.72 Choroidal detachments
364.04 Secondary iridocyclitis, noninfectious
364.22 Glaucomatocyclitic crises
364.53 Pigmentary iris degeneration
364.73 Goniosynechiae
364.74 Pupillary membranes
364.77 Recession of chamber angle
365.00-365.04 Glaucoma suspects
365.10-365.9 Glaucoma
368.40-368.45 Visual field defects
377.00-377.04 Papilledema
377.13 Optical atrophy, retina
377.14 Glaucomatous atrophy (cupping) of optic disc
377.15 Partial optic atrophy
377.21-377.24 Other disorders of optical disc
377.39 Optic neuritis, other
377.41-377.49 Other disorders of optic nerve
377.51-377.54 Disorder of optic chiasm
377.61-377.63 Disorders of other visual pathways
377.9 Unspecified disorder of optic nerve and visual pathways
743.20-743.22 Buphthalmos
743.58 Vascular anomalies

My feeling is that of the codes above, the ones you will be dealing with most are Glaucoma Suspect, Glaucoma and Visual field defects. Most of the other codes are handled by a full opthalmic practice.

Hope this helped.

Sincerely,

Andrew Roy
President
opticXpress