Medicare Reimbursement for Extended Ophthalmoscopy
EO is a detailed examination and drawing of the fundus that goes beyond the standard funduscopy of an eye exam. Pupil dilation is implicit; binocular indirect ophthalmoscopy (BIO) is preferred; it may include scleral depression. It is identified in CPT as 92225 (Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial) and 92226 (subsequent).
CPT further states, “Routine ophthalmoscopy is part of general and special ophthalmologic services whenever indicated. It is a non-itemized service and is not reported separately.”
EO is indicated for a wide range of serious posterior segment pathology.
This FAQ addresses the following:
- What is extended ophthalmoscopy (EO)?
- What is the difference between 92225 and 92226?
- What diagnoses support the use of 92225 and 92226?
- If BIO of the fundus is normal, may 92225 or 92226 be claimed?
- What documentation is required in the medical chart to support this service?
- How large do the retinal drawings need to be?
- What other attributes make a high quality EO retinal drawing?
- What does Medicare allow for 92225 and 92226?
- How frequently is this test performed?
- What other issues impact EO?
A list of common diagnoses is also included.
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