What documentation is required to support claims for extended ophthalmoscopy?
Although each Medicare carrier’s published policies contain specific documentation requirements that are not always identical, some points are common throughout: • A retinal drawing is a necessary component of the documentation. The drawing should include sufficient detail, standard color, and/or appropriate labels. • The retinal drawing must be maintained in the patient’s record. • Documentation must be legible. Most LMRPs simply state that the drawing must be “detailed,” but some do require that the drawing be at least 2 to 3 inches in diameter. (It’s difficult to document sufficient detail in a smaller drawing.) To be reimbursed for subsequent extended ophthalmoscopy (92226) you must also include evidence of change (e.g., worsening or progression) that warrants repeated examination. Q: What are reimbursement amounts for this test? Extended ophthalmoscopy is defined as a unilateral test. In 2002, the national Medicare fee schedule allows $22.44 per eye for the initial exam (92225) an
