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Fundus Photography

Chery Posted Wed 10th of October, 2012 15:58:18 PM

If a primary care doctor does fundus photography in their office on a patient with diabetes and retinal specialist interprets pictures in their office without seeing patient what dx code would be acceptable? I know what modifier's to use, but I am unsure of the dx. Also, should they sign an ABN.

SuperCoder Answered Wed 10th of October, 2012 16:30:53 PM

If the ophthalmologist performs fundus photographs with other diagnostic procedures to document a disease process or follow its progress, knowing which of the services -- and diagnoses -- to code can be confusing.

Any carrier that follows Correct Coding Initiative (CCI) edits will consider 92133 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve) and 92250 to be bundled. They are mutually exclusive, so it would not be appropriate typically to bill for both in the same visit.

CCI marks this bundle with a modifier indicator of "1, meaning you may be able to report them together by appending a modifier to 92133. But payers will want you to have documentation supporting your decision to code both procedures that meet the guidelines to allow unbundling as defined by the CCI edits.

Example: The ophthalmologist is monitoring a patient who has glaucoma and diabetic retinopathy. He checks the glaucoma’s progression with a scanning laser test (92133) and takes fundus photographs (92250) to track changes in diabetic retinopathy. Be sure you link a glaucoma diagnosis, such as 365.11 (Primary open-angle glaucoma), to 92133, and a diabetic retinopathy code, such as 362.05 (Moderate nonproliferative diabetic retinopathy), to 92250.

Your documentation must support the medical necessity for each test. In such a situation, you may want to have the patient sign an advance beneficiary notice of non-coverage (ABN) in case the carrier denies the claim.

Chery Posted Wed 10th of October, 2012 17:20:47 PM

Not exactly what I am asking. The fundus photography is not done by the ophthalmologist it is being done by a primary care physician with a kind new camera and is an undilated exam. The ophthalmologist is reviewing pictures online. I guess my question is will medicare/commerical pay on a 250.XX code if the patient is a diabetic and having this test by primary physician and being reviewed by an ophthalmologist.

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