Sometimes diagnostic tests are billable to Medicare and other payers, sometimes they are not. In this month’s column, I’ll focus on tests related to diabetes.
Common tests ordered by retina specialists include scanning computerized ophthalmic diagnostic imaging (SCODI-P), OCT angiography (OCTA), fundus photography (FP), FP with autofluorescence (AF), fluorescein angiography (FA), and/or indocyanine green angiography (ICG) testing. The codes for these tests are presented in the table below.
|92134||Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina|
|92235||Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral|
|92240||Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral|
|92242||Fluorescein angiography and indocyanine green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral (new code in 2017)|
|92250||Fundus photography with interpretation and report|
Suzanne L. Corcoran, COE, is executive vice president and founder of Corcoran Consulting Group (CCG), San Bernardino, California, which specializes in coding and reimbursement issues for ophthalmic practices.
FROM THE PAGE TO THE PATIENT
We continue to receive questions about billing for these tests. Let’s explore real-world examples that will serve to illustrate common scenarios.
Diabetes With Retinopathy
Your 74-year-old Medicare patient with Type II diabetes on oral hypoglycemics presents for an examination after a 5-year lapse. You note mild nonproliferative DR in both eyes; at this time there is no DME in either eye. Importantly, prior exams were negative for diabetic changes. For a more detailed evaluation and to permit re-evaluation, you order and perform fundus photos. In addition to the exam (shown as 9xxxx), the claim will read as shown in Figure 1.
Fluorescein Angiography for DR
You are a retina specialist consulted by another eye care provider concerning a patient similar to that in the example above, but in this case you order FP and FA of the retina of both eyes and document your findings in your report. In addition to the exam (shown as 9xxxx), the claim will read as shown in Figure 2.
FA is a bilateral procedure in 2017; for dates of service before Jan. 1, 2017, it was a unilateral code. Fundus photography is not bundled with FA.
OCTA and SCODI-P of the Retina for DR
You are a retina specialist consulted by another eye care provider concerning a 28-year-old man with blurred vision in both eyes; he is a Type I diabetic and takes insulin. He has had difficulty in the past with access to his veins. Your dilated fundus exam identifies proliferative DR in both eyes. You order SCODI-P of the retina and OCTA of the retina of both eyes and document your findings in your report, and SCODI-P shows no DME. In addition to the exam (shown as 9xxxx), the claim will read as shown in Figure 3. Because both SCODI-P and OCTA are coded as 92134, it is reported only once. RP