Ophthalmology and Optometry Coding Alert

Question: Primary care physicians (PCP) in our rural community sometimes ask our ophthalmologists to provide the interpretation and report on photos taken in their office for patients with known diabetic retinopathy. Should we report 92250 appended with modifier 26?

Washington Subscriber

Answer: This case is an example of telehealth, so you wouldn’t use 92250 (Fundus photography with interpretation and report) to report this service for patients with known retinopathy. Instead, you’d use 92228 (Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral) and append -26 (Professional component) to bill the ophthalmologist interpretation and report, which currently pays $16.60. The PCP’s office will bill 92228-TC (Technical component …), and they’ll receive $12.88.