Optometry Coding & Billing Alert
READER QUESTION ~ Track Disease Progress With 92285
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Question: We saw a patient after a scleral buckle procedure by another surgeon. The patient had
complications of extruding exoplant and strabismus. Our ophthalmic photographer took nine external photos to document the complication. Is there a code for these external photos?
Pennsylvania Subscriber
Answer: CPT code 92285 (External ocular photography with interpretation and report for documentation of medical process [e.g., close-up photography, slit lamp photography, goniophotography, stereophoto-graphy]) describes external photos, but it may not help in your case.
Why not? HGSA, the Part B carrier for Pennsylvania, stresses that 92285 is just for photos taken to track the progression (or lack of progression) of a disease, or to track the progression of a particular course of treatment.
-While many conditions of the eye could be photographed, this procedure should not be used to simply document the existence of a condition in order to enhance the medical record,- says HGSA's local coverage determination for 92285. Several other carriers voice this same warning.
Also, note that the procedure includes -interpretation and report- -- coders who do report 92285 should be sure that an interpretation and report specific to the external ocular photographs are kept in the patient's record, available to the carrier upon request.
Although you can argue for photos to be covered in the above scenario, it would be prudent to have the patient sign an advance beneficiary notice (ABN) before taking the photos.
You should also weigh the cost in pursuing payment for this service if it doesn't happen often. It may be better just to absorb the service if the carrier denies it as not medically necessary.
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