Enter 2020. CPT codes 92225 and 92226 are now inactive in the current CPT set. They have been replaced by two new codes that now have a much more specific definition of the procedure required. The two new codes are2:
92201 - Ophthalmoscopy, Extended; With Retinal Drawing and Scleral Depression Of Peripheral Retinal Disease (Eg, For Retinal Tear, Retinal Detachment, Retinal Tumor) With Interpretation And Report, Unilateral Or Bilateral
92202 - Ophthalmoscopy, Extended; With Drawing Of Optic Nerve Or Macula (Eg, For Glaucoma, Macular Pathology, Tumor) With Interpretation And Report, Unilateral Or Bilateral.
Note that the preamble for the codes remain the same. Extended ophthalmoscopy is indicated only when another less invasive test can provide the necessary information for the physician to diagnose, treat, or appropriately follow the management of the patient’s clinical condition.
The two new codes not only specifically define the area of the retina that must be examined, central retina for 92202, and in the case of 92201, it also defines and requires the use of the clinical technique of scleral depression to examine the peripheral retina. If you omit scleral depression or there is no notation of that technique in the record, then the definition of the code has not been fulfilled and would fail upon audit.
The other significant change is that the tests are both now defined to be “unilateral or bilateral” meaning that one would bill the code only as a single line item with the quantity of 1 when performed on one eye or both, thus effectively reducing the reimbursement for the new codes as compared to the prior codes by approximately 50 percent.
CPT Professional Edition, American Medical Association, 2019, pg.650
CPT Professional Edition, American Medical Association, 2020, pg 658