Ophthalmology and Optometry Coding Alert

Hint: 92250 plus these diagnostic tests should add up to $75 per patient

 In 2003, Medicare allowed over 1.5 million charges for fundus photography, reimbursing eye practices over $100 million - and to get your fair share, you need to be sure you're following these diagnostic-procedure coding guidelines.
 
Ophthalmologists often take fundus photographs in tandem with other diagnostic procedures, to document a disease process or follow the progress of a disease. But trying to code for all the services performed along with fundus photography can be tricky. Find Separate Reasons for Fundus and FA Many ophthalmologists perform 92250 (Fundus photography with interpretation and report) and 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) together as a standard of care. And there's no problem coding for both - as long as you have an order and written interpretation for both, says Donna Marks, CPC, CCS-P, OCS, ophthalmology coder for the Lahey Clinic in Peabody, Mass. Note that both descriptors specify that the codes include the interpretation and report. The ophthalmologist needs to document them separately for each procedure, Marks says.
 
Key: The two tests are done for different reasons, experts say. Fundus photography (also known as a "red freeze" or "color" photograph) is one photograph of the back of the eye, using a special camera that takes a color photograph of the retina. The ophthalmologist orders fundus photography to document what he finds upon examination and so he can take another photograph later and compare it to the first. This helps him judge any progression in the disease process that may have taken place between examinations.
 
Fluorescein angiography involves injecting fluorescein dye into a vein in the arm and then taking a series of photographs, using a motorized camera, as the dye travels through the vasculature of the retina. Fluorescein angiography allows the ophthalmologist to detect leaks in the vasculature.
 
Medicare carriers should have no objection to coding both tests - in fact, many won't have it any other way. "Medicare will cover fundus photography if accompanied by fluorescein dye angiography when used to evaluate abnormalities or degeneration of the macula, the peripheral retina or the posterior pole," says a local coverage determination (LCD) from First Coast Service Options, the Part B carrier for Florida and Connecticut. Many carriers, such as Palmetto GBA in Ohio, South Carolina and West Virginia, will only cover stand-alone fundus photography done by the surgeon of record for "therapeutic assessment of recently performed retinal laser surgery."
 
Watch out: Not all angiographies are created equal, says Jacqueline Arriola, CPC, coder for Yuma Eye Associates in Arizona. NCCI bundles 92250 into 92240 (Indocyanine-green angiography [includes multiframe imaging] with interpretation and report), which means that Medicare considers [...]