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Extended Ophthalmoscopy OutlineRobert P. Wooldridge, O.D.IntroductionMy experience learning extended ophthalmoscopyWhy we need to be able to do extended ophthalmoscopyNecessary to rule out retinal tears/detachmentNecessary to evaluate patients with flashes/floaters complaintsHelpful with evaluation of maculopathy patientsAge-related macular degenerationDiabetic retinopathyCystoid macular edemaEpiretinal membraneWhat constitutes extended ophthalmoscopy?See definition from CPTSomething more than one’s usual exam CPT Code definition92225 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; INITIAL92226 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; SUBSEQUENTWhen is extended ophthalmoscopy indicated?Medical necessityCovered diagnosesFrom Codesafe Plus: Currently there are no associated ICD-10 codes for 92225. This means that your local Medicare Carrier currently does not have a policy regarding this particular CPT code and specific covered diagnosis codes. This also means that there is no established policy that governs how you use this code in your practice which can actually work to your advantage since a carrier cannot deny a claim based upon a policy that simply doesn't exist. In most cases, the local standard of care, appropriate medical necessity noted in the medical record, and the prevailing CPT/ICD definition(s) in addition to your professional medical opinion will govern coverage of this procedure.”CMS Maximum allowable$26.34Demonstration of BIO examination Patient positioningProne vs sittingDemonstration of ability vs inability to properly position patient and examiner when patient is seated vs proneHead turn and tiltExaminer positioningRight or left side of patient?Location of examiner head Remember! Light travels in a straight line! You must have your head located where the fundus image is!Bend at the waist in order to attain proper head positionOrientation of examiner head:Examiner’s eyes should be perpendicular to long axis of patient’s pupilLens Hand Lens held in hand on lower side of patient’s faceLens hand rested on infra-orbital rimLeaves free hand to retract upper lidVisual aperture should be limited by the dilated pupil, not the lid!Be sure lid is fully retracted and not covering part of the pupilExamination light positionShould be ABOVE center of viewDemonstration of proper scleral depression techniqueDepressor held in hand on side of eye to be depressed so…You must be equally adept at holding the lens in either hand and…You must be equally adept at holding the depressor in either handPush lid back with depressorAppropriate amount of pressure to be appliedRoll the depressor back and forth to maximize effectFundus contact lens with slit lamp examinationLens typesMacula lens without mirrorIndicationsWhat can/cannot be viewedAdvantages/disadvantagesThree mirror lensIndicationsWhat can/cannot be viewedAdvantages/disadvantagesPanretinal lensIndicationsWhat can/cannot be viewedAdvantages/disadvantagesLubricationGoniosol vs CelluviscPatient positioningUse assistant to help patient maintain proper positioningUse of various mirrors for different areas of retina Central lensMidperipheral lensPeripheral lensGonio lensExamination of the vitreousWithout lensLight positioningOcular positioningLight beam on HIGH!Room light OFF!With lensLight positioningOcular positioningDo NOT use diffuserLight beam on MEDIUM!Room light OFF!PhotographyLightingDiffuser: NOF-StopStill shotVideo ................
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