Ophthalmology and Optometry Coding Alert

Published on Tue Jun 27, 2017 PDF

Question: Our ophthalmologist uses a fundus camera frequently and we’ve been including payment for it in the ophthal­mologic services codes, but we had a consultant come in and tell us we should code it separately. Can you advise?

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Answer: The consultant was correct. Fundus photographs help the eye care specialist screen for diseases and track abnormalities in the retina and optic nerve, and you should use 92250 (Fundus photography with interpretation and report) to report these services.

This code describes taking fundus photographs — that is, photographs of the posterior segment of the inner aspect of the eye — to document alterations in the optic nerve head, retinal vessels and retinal epithelium. It can be used to document baseline retinal findings and track disease progression.

Medicare considers 92250 to be inherently bilateral. In other words, its reimbursement — in 2017, $66.75 — covers payment for both eyes. Therefore, there is no need to append modifier 50 (Bilateral procedure) to 92250 if the ophthalmologist performs it on both eyes.

The Correct Coding Initiative does not bundle the ophthalmologic services codes (92002-92014) with 92250, so you can report both services together when documented and medically necessary.  

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