Wiki Retinopathy Eye Exam Screening?

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anne32

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I guess I have two questions.
1) I am having a hard time finding how to code for diabetic retinopathy screening. From what I understand, 92250 can only be used if the patient has symptoms. What CPT and ICD-10 codes do we use if the patient does not have symptoms?

2)Our family practice owns the equipment and we are taking the pictures and then sending them to an ophthalmologist to interpret them. We have a contract with the ophthalmologist so we can bill entirely for the service. In this case could we bill 92250 if the patient has symptoms?

Thanks,
Andrea
 
E10.9 and E11.9 are for diabetic patients without any retinopathy.

The screenings you are doing are not 92250 level photos, technically. There are telemedicine codes which would be more appropriate. I don't have access to my code books right now, but they're there.

In reality, I would suggest that you do your patients a favor and refer them to either an optometrist or ophthalmologist for a comprehensive eye exam with dilated fundus evaluation. They do not have to see a retinal specialist for these initial exams. The unfortunate reality is that your patients will think they've had an eye exam when you do their photos and will not seek other care for evaluation for glaucoma or other eye diseases.

Just make sure that whomever you refer them to for these exams sends your office a report on every patient so your PCPs can meet their HEDIS requirements.

Tom Cheezum, O.D., CPC, COPC
 
I work for an FQHC and our patients are very low income and cannot afford to go to an ophthalmologist just for a screen. If we discover any abnormalities we refer them and try to get them set up with one of our contracted docs that have agreed to do so many free visits a year.
Back to the coding, I know what telemedicine codes you are referring to- 92227 and 92228. My understanding is these codes are for the physician to bill and then the ophthalmologist would be able to bill for interpreting the images. In our case, we are contracting with the ophthalmologist so we can bill for all of it. We do this because if a patients insurance denies or they are self pay, our fees are much cheaper than getting a bill from the ophthalmologist. Since we are billing for both pieces, wouldn't 92250 be appropriate? Or what code(s) would be?
 
Just found an article by Corcoran. It seems like you should bill the 92228 code since this includes an interpretation and report and is specific to telemedicine.

In general, most carriers, including Medicare, will not pay for 92250 unless there is pathology documented. The 92228 code seems to be payable by Medicare with or without pathology as long as you have an I&R.

Tom Cheezum, O.D., CPC, COPC
 
I bill Medicare for JVN/retinopathy screening using either a diabetes dx or a hypertensive dx (since JVNs will also detect hypertensive retinopathy) and then Z13.5

CPT: 92250-TC (with a 59 or XU modifier if attached to an optometry exam), 92285-TC-51

The patients do not seem to need a pre-existing diabetic retinopathy code, "just" diabetes
 
Retinopathy Screening

I too am at an FQHC. We are considering doing the retinopathy screening. Which code works for you when billing for the contracted doctor interpreting the images? Did you bill the charges to Part B or did they roll up in the G code? I would appreciate any information that you are willing to share.
 
scauleycpc said:
I too am at an FQHC. We are considering doing the retinopathy screening. Which code works for you when billing for the contracted doctor interpreting the images? Did you bill the charges to Part B or did they roll up in the G code? I would appreciate any information that you are willing to share.
Click to expand...

I am with an FQHC that is doing the RentinaVue. The code roll-ups into the G code. It is inclusive of your rate.

I have another question. How do you bill if only one eye was able to be read? Do you still bill the CPT code with a modifier or when the patient comes back you then bill it. The issue with this is we have to pay for the interpretation each time and now we are having to come out of pocket for a second read. Does anyone know?

Thanks.
 
You should be able to check your image quality before you send them for reading. Don't submit them the first time unless you get good quality images.

As I've mentioned before, please do your patients a favor and refer them to either an optometrist or ophthalmologist for a dilated retinal exam. One of the reasons I say this is that your images only capture a very limited area of the retina and I have seen many many patients with significant peripheral retinal diabetic bleeding which wouldn't show in your pictures' field of view.

I know your practice wants to generate the revenue from doing this but you are truly giving your patients a false sense of security for the reason I mentioned above plus, the image resolution of the RetinaVue is not the best to detect many minute retinal hemorrhages that a dilated exam will find.

I've been doing this for 40 years and you'd be surprised what your central retinal pictures are missing including retinal detachments/tears and melanomas. Unfortunately, when you do this imaging in your office, most patients will think they've had a thorough eye health exam.

I'll step off my soap box now.

Tom Cheezum, O.D., CPC, COPC
 
scauleycpc said:
Retinopathy Screening

I too am at an FQHC. We are considering doing the retinopathy screening. Which code works for you when billing for the contracted doctor interpreting the images? Did you bill the charges to Part B or did they roll up in the G code? I would appreciate any information that you are willing to share.
Click to expand...
Did you receive a response regarding this? We are billing 92250 with the E10.9 or E11.9 dx code however, insurance is applying to patient coins/deductible responsibility and not processing as a preventive service. Does this mean it needs a -PT modifier or -33 modifier to indicate the cost share for the patient is not applicable?
 
I work at FQHC and would anybody know what would be the codes to bill for Diabetes Retinal Screening? We would only bill for the imaging and we would send them to an ophthalmologist to interpret them.
 
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