Ophthalmology and Optometry Coding Alert

Question: Next month, one of our ophthalmologists will begin conducting remote diabetic retinopathy screenings in partnership with a PCP. The PCP will capture the images and transmit them electronically to our practice. Our doctor will review the images, call the PCP with the results, and if necessary, schedule a follow-up exam with our practice. How should we code these remote services?

California Subscriber

Answer: Adding a retina screening to a diabetic patient’s primary care visit helps eye care practices reach patients who aren’t currently under the care of an eye care professional — but should be. Telemedicine might seem trendy, but eye care-specific codes have been available since 2011.

• 92227 — Remote imaging for detection of retinal disease (e.g. retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral
• 92228 — Remote imaging for monitoring and management of active retinal disease (e.g. diabetic retinopathy) with physician review, interpretation and report, unilateral and bilateral.

In your case, the patients haven’t yet been diagnosed, so you’d use 92227. Here are the finer points:

• You might not get paid for 92227. While some payers recognize screenings as medically necessary, others do not.
• If you do get paid, it won’t be much. Your doctor is likely counting on adding DR patients to your practice as the real benefit of offering remote screenings.
• Don’t report either 92227 or 92228 with eye exam codes 92002-92014 or E/M codes 99201-99205. That would be like double-dipping — and those claims would be denied.
• When using 92227, don’t worry about who takes the photos or provides the imaging equipment. There’s no technical or professional component for this code. 
• For 92228, you’d bill it using modifier 26 for the professional component, while the PCP would bill it with modifier TC for the technical component.