92250 Fundus Photo

[bclements02]

I heard that some insurance companies are paying for a baseline Fundus Photo when billed with 250.00 diabetic with NO retinopathy. Has anyone heard of this and if so which insurances seem to be paying?

 

[erjones147]

Not sure about private insurance, but we're getting paid from Medicare for:

99250-TC
92285-TC-51

Dx: 250.xx, V80.2

 

[domaha28]

? Tc

So you are billing for the technical component doing the test? Will whoever is reading the test bill 92250 26? We had a rep come in from Welch Allyn and they said we could bill the 92250 but we would own the equipment, perform the test but someone else would be interpreting the results. I don't know why but this is confusing to me.

 

[Cheezum51]

I'm not aware of any major medical carrier that will pay for baseline fundus photos when no pathology is present.

Some medicare local carriers may be paying incorrectly but, most likely, if your records are audited and they see that the photos don't show any pathology, you will have to refund the money to Medicare plus possibly incur penalties.

I have read information from several sources on this and doing what you are doing should not be billed to MC and will eventually lead to major problems for you. Understand that 92250 is one of the codes that OIG is targeting for audits!

If you want to do baseline fundus photos, without pathology, the patient should be paying for those out of pocket and you should have them sign an NEMB form.

Tom Cheezum, O.D., CPC

PS - coding in a way that gets you paid for something that isn't covered isn't proper coding. Not saying you're doing this, but I've seen several practices that do that and most eventually get nailed for it.