Ophthalmology and Optometry Coding Alert

Question: One of our physicians wants to know if we can bill for indocyanine-green dye. He said it is used for membrane peels and complex cataract surgery in an ambulatory setting. He said it is $125 a vial. Can we bill for this? If so, what is the CPT code, and is there a specific diagnosis that would also go along with this?

Ohio Subscriber

Answer: You should not separately report the indocyanine-green (ICG) dye itself. Using the ICG dye is considered part of the procedure. You'll report CPT code 92240 (Indocyanine-green angiography [includes multiframe imaging] with interpretation and report) for this procedure.

Similar situation: The guidelines for reporting ICG dye are the same as when you report a fluorescein angiography (92235, Fluorescein angiography [includes multiframe imaging] with interpretation and report): You don't report the actual fluorescein dye used in the procedure. 

Diagnosis solution: Contact your local Medicare carrier to determine the diagnosis codes that support the medical necessity for an ICG angiography. If your ophthalmologist has documented one of the appropriate diagnoses, you can report 92240 and expect to be paid.

Example: The local coverage determination (LCD) for Palmetto GBA in Ohio lists the following ICD-9 codes as diagnoses that support medical necessity for 92240:

• 362.16 -- Retinal neovascularization NOS

• 362.43 -- Hemorrhagic detachment of retinal pigment epithelium

• 362.52 -- Exudative senile macular degeneration

• 362.81 -- Retinal hemorrhage

• 977.8 -- Poisoning by other specified drugs and medicinal substances

• 995.20 -- Unspecified adverse effect of unspecified drug, medicinal and biological substance

• 995.29 -- Unspecified adverse effect of other drug, medicinal and biological substance.

Note: The fact that these diagnosis codes support medical necessity does not guarantee reimbursement. You can review the LCD for ICG online at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=7404&lcd_version=45&show=all.