Optometry Coding & Billing Alert

Published on Tue Jun 06, 2006 PDF

Question: I would like to offer baseline photos, taken with my fundus camera, for patients who are interested. Can I charge a different fee compared to photos taken to monitor disease that include an interpretive report?

Texas Subscriber

Answer: You can if you bill for just the technical component of the fundus photos. Report 92250-TC (Fundus photography with interpretation and report; technical component). Append modifier TC to show that you just performed the technical portion of the procedure, not the professional component (modifier 26, Professional component) of interpreting and reporting the results.
 
Another option: Bill the photos with 92499 (Unlisted ophthalmological service or procedure).
 
Since Medicare will not cover baseline fundus photos, you should also have the patient sign an ABN and append modifier GA (Waiver of liability statement on file).
 
You may also want to give a form to new patients explaining the advantages of retinal photography and that Medicare will not cover it. The patient can then check -yes- or -no- on the form to indicate that he does or does not accept the procedure and is or is not willing to be responsible for the charge for the photos.
 
However, some optometrists do not even offer baseline retinal photos as an option to Medicare patients, reasoning that it is not worth the risk.