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Fundus Autofluorescence Photography

  1. #1
    Question Fundus Autofluorescence Photography
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    Can anyone tell me what CPT code(s) to use for Fundus Autofluroesence Photography??
    Is anyone billing for it??

    Thank you,

  2. Default
    Hey Sheila,
    You want to use 92250 for Fundus Autofluorescence photography. Check with your Medicare LCD to see what documentation and Dx meets medical necessity. Most Medicare MACs will allow a couple or more photos a year so you can track the progression of a disease if it “effects the management”. A lot of clinicians have been using Autofluorescence to track conditions like AMD.

    Also make sure that there is a separate interpretation and report for the photos.

    Hope this helps.

    John Uecke CPC, CPMA, CHA, COBS, CMOM, OCS

  3. Default
    We have an endocrinologist that would like to perform and bill for a fundus exam and he would send the report to be read by an outside physician. Can a non-optho physician bill and get reimbursed for a fundus exam?

  4. Default Oct and Fundus

    I have a couple questions regarding fundus photography CPT 92250 reimbursement. The doctors in our practice are thinking about buying a new fundus camera & spectral domain OCT.

    1) We have been told from several manufacturing OCT reps that you can use the SLO (scanning laser ophthalmoscope) scan on the OCT for fundus photography 92250 reimbursements. They claim that the SLO fundus image is considered to be equal to a standard digital fundus camera? So, can one OCT be used for both 92133, 92134 & used for fundus photography 92250? Is this true?

    2) Some of the new fundus cameras on the market do not use the traditional digital camera. Does a new style SLO generated fundus scan qualify for 92250 reimbursements?

    Thank you,

  5. #5
    To Eye:
    An OCT is an OCT and Fundus photos are fundus photos. One uses optical coherence and the other is digital photography. OCT optic nerve used for glaucoma to check for nerve fiber damage is 92133. OCT retina used for macular edema and retinal detachment is 92134. Fundus photos, different instruments, with/without autofluorescence is used to check cup/rim in glaucoma and provides a detailed view of vascular components of choroid as in CRVO/BRVO,etc is 92250. Per current NCCI edits you cannot bill 92133/92134 with 92250 unless there is medical necessity-different illness in other eye. Years back a hefty fine was imposed for billing these two tests together in the same session. While it is true OCT data can be used to give similar information as fundus photos they are not the same test. All of these are inherently bilateral with a -TC and -26 component.

  6. #6
    To Pride,
    For reasons too involved and explanations too long to discuss in this post tell your endo doc to refer his patient to an ophthalmologist. It will save him/her a big headache.

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