Make the Mo$t of Your Claims for Fundus Photography
Published on Tue Oct 14, 2003
At the very least, you want to avoid fraud charges. At most, you want to get every penny your practice deserves. You can do both by learning Medicare's and private carriers' specific policies regarding billing for fundus photography (FP).
Fundus photography, 92250 (Fundus photography with interpretation and report), is a common procedure that a technician performs using a fundus camera attached to an ophthalmoscope, which is aligned to view the back of the eye. Pictures are then taken of the optic nerve head, vitreous, macula, retina and its blood vessels to document any present pathology. Locate the Correct Code You can find 92250 in the CPT special ophthalmological services section, which is a compilation of services that practices may report for Medicare and some other insurance companies in addition to the general ophthalmological services (92002-92014) or E/M services (99201-99499).
The majority of codes in the special ophthalmological section are for diagnostic tests, i.e., 92083 (Visual field examination, unilateral or bilateral, with interpretation and report; extended examination [e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2]), 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral), and 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report). Use FP to Diagnose and Document Though ophthalmologists can use fundus photographs to diagnose certain eye conditions, they more often use them to document a disease process or a diagnosis the physician has already observed. As a result, many ophthalmologists do not comply with the interpretation and report component of the code.
Ophthalmologists use fundus photography to document what the physician has seen upon his or her physical examination of the patient, says Lise Roberts, vice president of Health Care Compliance Strategies, a Jericho, N.Y.-based coding, reimbursement and compliance consulting company. "The physician orders fundus photography so that at a later time a subsequent photograph can be taken and used as a comparison to the initial photograph. This assists the physician in judging any progression in the disease process that may have taken place between examinations."
However, fundal photography is not merely a glorified ophthalmoscope. "The value of fundus photography is for longitudinal analysis of the progress of a disease and should not be performed unless the patient has a disease that warrants it," Roberts says. "Otherwise, it is not generally medically necessary to do more than one a year. The frequency has to be medically justifiable." Check if Carriers Consider FP Unilateral or Bilateral CPT defines a visual field examination as "unilateral or bilateral," and Medicare defines it as bilateral only. Both definitions [...]
