Big changes to an old pair of codes

This year’s list of new CPT codes for eye care is small. However, it’s important to understand a couple of changes to a pair of codes we commonly use.

If you work in a primarily retina or glaucoma specialty practice, you’ll no doubt know about the nerve and retina drawing codes, which are known in CPT as “extended ophthalmoscopy.” There have long been two codes, with the only difference between them being whether it was done as an initial drawing of the fundus of one eye or a subsequent drawing. Those two services in 2019 and prior years have been designated by CPT codes 92225 (initial) and 92226 (subsequent).

Both 92225 and 92226 have been unilateral services, which means that they could be billed per eye if pathology was present and the drawing otherwise adds to the examination by the provider. For 2020, both of these longstanding codes are being deleted and therefore cannot be used after Dec. 31, 2019.

The new codes

Replacing these codes are two new CPT codes: 92201 and 92202. The new codes are divided primarily by the anatomy being drawn.

92201 is defined as, “Ophthalmoscopy, extended, with retinal drawing and scleral depression of peripheral retinal disease (e.g., for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral.”

Note that 92201 is only for peripheral retinal drawings and that scleral depression is required to meet 92201, so that subtlety should be documented in the record as well.

92202 is defined as, “Ophthalmoscopy, extended, with drawing of optic nerve or macula (e.g., for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral.”

92202 is only for use when the drawing is of the central retina and/or optic nerve. Notice the lack of scleral depression in this code descriptor, which means it can be met whether or not this is done.

How the codes are similar

As before, an interpretation and report also is required before the documentation is complete and billing is possible. A prior OP coding column on what constitutes proper “interpretation and report” documentation can be found at bit.ly/316Coding .

Also important is that this code is not reported on the same day as fundus photography (CPT 92250). The current policies for the deleted extended ophthalmoscopy codes 92225 and 92226 note that in order for the service to be considered medically necessary and payable, they must be additive to the exam and any other testing performed on that day. No policies exist for these new codes, but they are likely to be similarly worded in regards to being additive.

How the codes are different

The codes 92201 and 92202 differ significantly from the deleted codes in that they are designated as unilateral or bilateral — meaning that they are no longer paid “per eye” and are reimbursed whether done on one or both eyes. Being bilateral makes them similar to how most of the other imaging platforms, such as OCT and fundus photography, are coded and reimbursed.

The designation of a drawing as either “initial or subsequent” is also eliminated, so the same code would be used in 2020 for the first drawing as for any subsequent drawing that shows any changes in the same anatomical area.

Payment for these new codes will be significantly less than the former codes, if done bilaterally. In 2019, the national payment for 92225 if done bilaterally under Part B Medicare was a bit more than $56 (twice the one-eye payment). The new 2020 payment is roughly equal to the old “1 eye payment,” but don’t forget that payment cannot be doubled since the code is now “unilateral or bilateral.”

As always, “good coding to you.” OP