Atlantic Posted Thu 24th of January, 2013 14:53:15 PM
Is a pentacam 92285 considered a medically necessary service for a diagnosis of cataract ? I could not find a Medicare LCD for our carrier that included or excluded this diagnosis. The LCD only details Blephroplasty.
SuperCoder Answered Fri 25th of January, 2013 18:05:27 PM
External Ocular Photography – 92285
Indications and Limitations of Coverage and/or Medical Necessity. This procedure may be indicated when photo-documentation is required to track the progression or lack of progression of an eye condition, or to document the progression of a particular course of treatment. While many conditions of the eye could be photographed, this procedure should not be used to simply document the existence of a condition in order to enhance the medical record.
Based on the patient's diagnosis, Medicare should cover the photography -- if your ophthalmologist is taking the photos to "track or treat" the disease. Medicare will typically cover 92285 (External ocular photography with interpretation and report for documentation of medical progress) if the ophthalmologist is either:
• tracking the progression of the disease, or
• checking the effectiveness of a particular course of treatment for the disease.
If the ophthalmologist conducts the photography for either of these purposes, you can report 92285 to Medicare. If you are unsure about your individual policy, contact your local Medicare carrier before filing the claim.
If the ophthalmologist obtains the photography to "track or treat" the disease, most Medicare payers will deem 92285 medically necessary based on the patient's diagnosis (190.0, Malignant neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid).
Other diagnoses that many Medicare carriers accept for 92285 include:
• the 190.x series (Malignant neoplasm of eye)
• the 364.5x series (Degenerations of iris and ciliary body)
• the 370.6x series (Corneal neovascularization).
But not all Medicare carriers observe the same ICD-9 guidelines for 92285, so check with your local carrier if you have any questions.