Ophthalmology and Optometry Coding Alert

Question: During a fluorescein angiography (FA), the ophthalmologist injected the dye but was unable to get photographs. We had to refer the patient elsewhere for the FA. Can we still code for our work?

Wisconsin Subscriber

Answer: The answer may depend on why the ophthalmologist was unable to obtain the photos. Append modifier 53 (Discontinued procedure) to 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) to show that the ophthalmologist was unable to perform the full diagnostic procedure and it was discontinued.

Reporting 92235 unmodified would not be an accurate representation of your ophthalmologist's work -- and it may lead to problems for the ophthalmologist you referred the patient to, when he attempts to report the code.

Part of the difficulty coders have with modifiers 52 (Reduced services) and 53 comes from physicians' interchangeable use of the words "cancelled" and "discontinued." To use 53, you have to be sure the ophthalmologist stopped the procedure after having started.

Don't miss: Many ophthalmologists perform 92250 (Fundus photography with interpretation and report) and 92235 together as a standard of care. You should be able to report both -- if you have an order and written interpretation for each test. Both descriptors specify that the codes include the interpretation and report. The ophthalmologist must document them separately for each procedure.

Key: The two tests are done for different reasons. 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.

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.