tci Part B Insider - 2015 Issue 44

Part B Coding Coach: Scope Out EO Coding Guidelines, or Risk $28 Each Time

Know when you can – and can’t – report this procedure separately. Is that ophthalmoscopy routine or extended? Is it included in the eye exam code, or can you bill for it separately? With approximately $28 at stake for each procedure (based on 0.76 RVUs multiplied by the 35.9335 conversion factor in 2015), CPT® codes 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and 92226 (… subsequent) appear quite frequently in claims from many optometry practices – including yours, most likely. Both beginning and seasoned coders often...

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