procedure code for retinal photos

1 ANSWERS

1. amomipais82
   

   Hi,
   As I currently don’t have a camera in the office, this is more an academic discussion for me, but I usually had one at hand. From a strictly medical billing standpoint, you can only bill for photos (CPT 92250) in the presence of appropriate pathology (CIGNA Medicare has, somewhere, a list of “appropriate” diag. codes). However, BCBSNC pays for “routine” photos in the context of a routine eye exam (same 92250 code!). I tend to agree with your approach of only documenting when there is something. One can start quite a philosophical discussion about the value of documenting normal in case there is ever future pathology, assuming that a sufficient percentage of patients ever develop pathology and that they see no other eye doctor than you for the next 25 years (hmmm, long shot). This is probably why most carriers don’t pay unless there is pathology. Now, many offices offer routine photos and “sell” it by making those points I mentioned. Those with an Optomap sell it as an alternative to dilation and say it is more sensitive at detecting some things (I worked with one for 2 years, and I can only lukewarmly agree with those points). In spite of the arguments made in favor of routine photos, it tends to be more of a profit center than anything else. Does that make routine photos inherently evil? I don’t know.
   One important point. Since there is only one fundus photo code (92250), there is only one way to bill/code for it. If you charge differently for routine photos than pathology photos, and some insurer decides to audit you, you may be in trouble. So, if routine photography is the rule in one’s office, it’s best to charge all patients the (usually) discounted fee offered on the solicitation sheet patients are given.
   Sorry for being long-winded.
   Hope this helps,

   Report (0) (0)  |   12 years, 7 month(s) ago