Optometry Coding & Billing Alert

Published on Mon Aug 08, 2005 PDF

Question: I'm not sure when I can and can't bill for slit-lamp photography. What are the rules?


Nebraska Subscriber

Answer: The main rule for reporting 92285 (External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit-lamp photography, goniophotography, stereo-photography]) is that you must be taking the photos to track the progression (or lack of progression) of a disease, or to document 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 the local coverage determination (LCD) from Part B carrier HGSA, using language found in several other carriers' policies.

HGSA specifically mentions one condition, saying that 92285 is not for the "general taking of photographs (i.e., photographic documentation to support the medical necessity for blepharoplasty)."

So, although you may need to have photos in the records of your pre-blepharoplasty patients, don't bill separately for them.

When can you report 92285? Photographs are not allowed by most carriers as a way to document the progression of cataracts, but among the ICD-9 codes that many carriers list as supporting medical necessity for external ocular photography are 190.0-190.9 (Malignant neoplasm of eye), 364.51-364.59 (Degenerations of iris and ciliary body) and 370.60-370.64 (Corneal neovascularization). Check with your local carrier for additional guidelines.