The answers to these FAQs about 92250 can earn you $82 per procedure|
Fundus photography -- CPT code 92250 (Fundus photography with interpretation and report) -- is one of the most frequently performed procedures in ophthalmology offices across the country. As a result many coders have questions about how best to report this diagnostic test in which a fundus camera attached to an ophthalmoscope takes pictures of the optic nerve head vitreous macula retina and its blood vessels to document any present pathology. Our experts'advice can steer you toward full reimbursement -- and away from denials.
Q: Is fundus photography considered unilateral or bilateral?
The CPT codes descriptor doesn't explicitly say whether 92250 is inherently unilateral or bilateral. According to Medicare's Physician Fee Schedule however it's a bilateral procedure. CMS values 92250 at 2.19 RVUs which multiplied by the current conversion factor of 37.3374 yields an allowance of $81.76. Column T of the fee schedule gives fundus photography a bilateral surgery indicator of 2 -- meaning that the RVUs are already based on the procedure being performed as a bilateral procedure.
But what if you only photograph one eye? "What we do is add modifier -52 (Reduced services) to 92250 " says Amanda Kunze CPC reimbursement specialist at the Eye and Ear Clinic of Wenatchee in Wenatchee Wash "and then the -RT or -LT modifier depending on which eye we did photograph."
Q: What if we just do the fundus photos - no exam no interpretation?
Report 92250-TC (Technical component) to show that you only performed the technical component not the professional component (the interpretation) of the procedure. "In some cases our office will do [a procedure] for a physician who does not have the particular equipment that we have " says Edith M. Johnson CPC ophthalmology coding specialist at the Springer Clinic in Tulsa Okla. "And so we'll code for the -TC and then the other surgeon bills for the -26 (Professional component)." The technical component of 92250 is valued at 1.54 RVUs ($57.50) while the professional component is valued at 0.65 RVUs ($24.26).
Q: What level of supervision is required? If a technician does the photography does the ophthalmologist have to be in the same room directly supervising?
No Johnson says. The "Level of Physician Supervision" for 92250 (found in Column Z of the Physician Fee Schedule Database) is 1 which means according to Medicare that it "must be performed under the general supervision of a physician." The physician maintains overall direction and control of the procedure -- but his presence is not required. In other words the physician must order the diagnostic test but need not be in the office when it's performed.
Q: Can we report 92250 on the same day as SLO (scanning laser ophthalmoscopy)?
Probably not Kunze says. …….
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