tci Part B Insider - 2012 Issue 42

Reader Question: Know What 92226 Entails

Question: I just got a denial on 92226. I think I might be using this code incorrectly. Can you explain what it’s for and when I can code it? Answer: Your ophthalmologist likely performs some form of ophthalmoscopy during any general exam. But you should use 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) and 92226 ( … subsequent) to report the service only when the provider does an extended ophthalmoscopy (EO). Key: Your provider is responsible for documenting the encounter and proving that an EO is medically necessary...

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