CPT Code 92202

CPT code 92202 is a medical billing code for extended ophthalmoscopy with drawing on the retina.

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What is CPT Code 92202

CPT code 92202 is used to document a medical procedure involving an extended ophthalmoscopy with drawing, performed on either the retina or the optic nerve. This code is specifically utilized when the healthcare provider needs to conduct a detailed examination and mapping of the eye's interior structures, which is crucial for diagnosing and managing various ocular conditions. The drawing is an essential part of the documentation, providing a visual representation of the findings.

Does CPT 92202 Need a Modifier?

For CPT code 92202 (Ophthalmoscopy, extended; with drawing of optic nerve or macula), the application of modifiers can be essential depending on the specific circumstances of the procedure performed. Here is an ordered list of common modifiers that might be used with this CPT code and the reasons for each:

1. -26 (Professional Component): This modifier is used when only the professional component of the service (interpretation of results, for example) is provided. It is applicable if a different provider or entity performs the technical component.

2. -TC (Technical Component): This modifier is used when only the technical component of the service (the actual performance of the ophthalmoscopy) is provided. This is applicable if the interpretation is performed by a different provider.

3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye was examined. Since ophthalmoscopy can be performed on one or both eyes, these modifiers help in specifying the eye involved in the service.

4. -50 (Bilateral Procedure): This modifier is used if the procedure is performed on both eyes during the same session. It indicates that the service was bilateral, which might affect reimbursement.

5. -22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation should support the extra work and reason for it.

6. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly relevant if other procedures are performed on the same eye during the same session.

7. -76 (Repeat Procedure by Same Physician): This modifier is used if the procedure is repeated by the same physician on the same day. This could be applicable in cases where initial ophthalmoscopy findings necessitate a repeat examination.

8. -77 (Repeat Procedure by Another Physician): Similar to -76, but used when the procedure is repeated by a different physician on the same day.

Each of these modifiers serves to provide clarity and specificity about the service provided, which is crucial for accurate billing and reimbursement in healthcare revenue cycle management. Always ensure that documentation supports the use of any modifiers to avoid issues with claims processing and audits.

CPT Code 92202 Medicare Reimbursement

CPT code 92202, which refers to "ophthalmoscopy, extended; with drawing of optic nerve or macula (e.g., for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral," is reimbursable by Medicare. The reimbursement for this code can vary based on the geographic location and the setting in which the service is provided (e.g., office vs. facility). To determine the specific reimbursement amount, it would be necessary to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through a Medicare Administrative Contractor (MAC) that services your specific geographic area. These resources provide detailed and updated information on the reimbursement rates applicable to different services.

Are You Being Underpaid for 92202 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 92202 for extended ophthalmoscopy with retinal drawing. Schedule a demo today to see how RevFind can help you secure correct payments from each payer, ensuring your financial operations are as efficient and accurate as possible.

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