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Fundus Photo 92250

Gail Posted Thu 15th of August, 2013 12:50:44 PM

Can Fundus Photo 92250 be considered or fall under "Diagnostic Lab"
Our Pt's insurance is processing this code under her "Diagnostic Lab" benefit.

Thank You

SuperCoder Answered Fri 16th of August, 2013 11:54:46 AM

Yes ,with the advent of a new and revised coding system for the diagnostic tests collectively known as Scanning Computerized Ophthalmic Diagnostic Imaging, or SCODI, a barrage of questions has emerged amidst confusion. This review addresses these issues regarding optical coherence tomography and pertains to Medicare only. Other insurers are making independent decisions and may be slow in their implementation. Each insurer should be contacted directly.

The origin of the fundus photo bundles with SCODI dates back to when the code was first developed. Many practices were billing for both tests but not actually performing separate fundus photos; they were merely part of the SCODI test (a recreation of the optic nerve). Do not unbundle them unless your Medicare contractor specifies that it is allowed. A draft policy that does is currently posted for First Coast Service Options in Florida. It remains to be seen whether it is put into effect or not.

Fundus photos (CPT code 92250) and OCT for retina (CPT code 92134) are bundled mutually exclusively in the NCCI.

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