Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performs external ocular photography for a Medicare patient with a malignancy on her left eyeball. Is this a covered service?

New York Subscriber

Answer:  Based on the patient's diagnosis, Medicare should cover the external photography -- if your ophthalmologist is taking the photos to "track or treat" the disease. Medicare will typically cover 92285 (External ocular photography with interpretation and report for documentation of medical progress) if the ophthalmologist is either:

• tracking the progression of the disease, or
• checking the effectiveness of a particular course of treatment for the disease.

If the ophthalmologist performs the photography for either of these purposes, you can report 92285 to Medicare. If you are unsure about your individual policy, contact your local Medicare carrier before filing the claim.

If the ophthalmologist obtains the photography to "track or treat" the disease, most Medicare payers will deem 92285 medically necessary based on the patient's diagnosis (190.0, Malignant neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid).

Other diagnoses that many Medicare carriers accept for 92285 include:

• the 190.x series (Malignant neoplasm of eye)
• the 364.5x series (Degenerations of iris and ciliary body)
• the 370.6x series (Corneal neovascularization).

But not all Medicare carriers consider the same ICD-9 medically necessary guidelines for 92285, so check with your local carrier if you have any questions.