Ophthalmoscopy for Flashers & Floaters

A patient reports flashes & floaters; however the ophthalmologist doesn't find evidence of retinal pathology on routine ophthalmoscopy. Considering this, are we justified in billing for extended ophthalmoscopy (EO)?



Answer: If the ophthalmoscopy is a routine part of a patient's eye exam, you should not bill for it separately.



But then complaints of flashers and floaters are always grave and must be evaluated watchfully. Many a time these symptoms will justify extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing example, for retinal detachment, melanoma], with interpretation and report; initial).



To report a Goldmann-3 exam (examining the retina with a three-mirror goniolens) go for 92225. Remember to provide your formal interpretation and report the findings in the patient's medical record.



In many instances in which flashers and floaters are present, extended ophthalmoscopy (EO) combined with a retinal exam shows vitreous degeneration or posterior vitreous detachment (379.21, Vitreous degeneration). If an ophthalmologist doesn't see anything in the routine ophthalmoscopy, he'll most likely not do an EO.



In the unlikely event that the ophthalmologist does not find any important problem with the retina after the EO, link 92225 to 379.24. 'Vitreous floaters' appears in a note under that code in the ICD-9 manual. If the ophthalmologist doesn't see floaters, take a look at the 368.1x series.



However: If the ophthalmologist cannot see anything more with an EO than he can see with a routine ophthalmoscopy, defending the use of the EO may be tough. Some experts recommend not billing for an EO unless there's some abnormality of the retina or vitreous to draw in the report.



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