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Ophthalmology and Optometry Coding Alert

Reader Question:

Give the Full Picture on Fundus Photos

Published on Sat Oct 10, 2009

Question: If you perform 92250 (fundus photography) on a patient with diabetes and later find out that there is no retinopathy diagnosis that you can bill with this procedural service, will any insurance provider pay for it? It seems to me that a diabetes diagnosis would make this procedure medically necessary as a baseline even if there is no retinopathy. Alabama Subscriber Answer: You cannot bill for photos, even for a diabetic patient, if the patient has not been diagnosed with retinopathy. Only when retinopathy is present can you bill for fundus photos. A mere photograph of the retina cannot be used to establish a baseline for diagnosis and billing. CPT defines code 92250 as "fundus photography with interpretation and report." In this particular service, there are several integral parts: • the retinal image taken by the camera or other imaging tool, • the chart documentation, and • the professional [...]
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