Ophthalmology and Optometry Coding Alert

Question: I have not found any documentation that states 92235 and 92250 are bundled. A few of our doctors are saying that the photography code (92250) is bundled into the fluorescein, and that they should bill for the 92250 when only the photography is done. Do you have any documentation that would support these codes?

Ziecha Rummel, Medical Coder
Corvallis Clinic, Ore.

Answer: Code 92235 (fluorescein angiography [includes multiframe imaging] with interpretation and report) and 92250 (fundus photography with interpretation and report) are not a bundle in the Correct Coding Initiative. However, there must be a valid diagnosis for each code to use both. Its important to remember that 92235 is a unilateral code; that means Medicare will pay for each eye if medically necessary for each eye. If there are no symptoms or pathology for one of the eyes that warrants a 92235, the performance of that service is not medically necessary for that eye and should not be billed. Code 92250, on the other hand, is a bilateral code, which means Medicare includes payment for doing the service on one or both eyes and will be paid only once.

If it is medically necessary to perform 92250 on only one eye, it is still appropriate to bill the service because the fee schedule is for one or both eyes. The order for both services must be documented in the treatment plan, as well as an indication for which eye (or both eyes, if applicable) the services are being ordered.