Print | ShareCPT Code: 92285 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: External Ocular Photography
Category
Special Ophthalmological Services
Description
External ocular photography is a procedure to document the progress or deterioration of conditions of the external structures of the eye including the eyelids, lashes, sclera, conjunctiva and cornea.
This Medicare carrier does not have a local coverage determination (LCD) for external ocular photography. The policy presented is provided to serve as a sample for how other carriers allow the procedure to be billed and coded. It is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
External ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g., eyelids, lashes, sclera, conjunctiva and cornea). External photography techniques may also be used to document conditions related to structures of the anterior segment of the eye. These would include the anterior chamber, iris, crystalline lens and filtration angle.
External ocular photography is accomplished by using a close-up hand-held camera, a slit-lamp-integrated camera, photography through a goniophotography lens or with a close-up stereo camera. In any case, the resulting photographs may be prints, slides, videotapes or digitally stored.
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.
Identification and/or follow-up of the following:
- Disorders of the globe
- Disorders of the iris and ciliary body
- Keratitis
- Corneal opacity and other disorders of the cornea
- Disorders of the conjunctiva
- Inflammation of the eyelids
- Other disorders of the eyelids
- Disorders of the lacrimal system
- Disorders of the orbit
- Other disorders of the eye
- Neoplasm of the eye
- Injury to the eye
- Systemic disease
ICD-10 Diagnosis Codes
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the external ocular photography.
2. The photographs should be permanently labeled with the patient’s name and date in addition to a notation of which eye is pictured.
3. The photographs should be print, slide, video or digital media.
4. An interpretation of the photograph(s) should be maintained in the patient’s medical record.
1. Report fundus photography with CPT code 92250. This is a bilateral service on the Medicare Physician Fee Schedule database. When it is medically necessary to photograph both eyes, the procedure is reported on a single service line without the -50, -RT or -LT modifiers and a unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. If only one eye is photographed, the -52 modifier is appended to the service line to indicate a unilateral service. In addition, the site modifier -RT or -LT must be used when the -52 modifier is used.
3. Fundus photography requires general supervision by the optometrist/ophthalmologist.
4. It may be necessary to take a series of photographs at one session to document the patient’s progress. However, CPT code 92250 should only be reported once for a series of photographs taken at one session.
5. An eye examination may be reported on the same day as fundus photography and if it is medically necessary.
1. External ocular photography may be performed when it is medically necessary to document the progress or deterioration of conditions of the eye. External ocular photography is not indicated for the purposes of documenting the existence of an ocular condition in order to enhance the medical record, and may be needed in order to track and serially compare the changes of the condition.
2. External ocular photography may be performed as needed to track the changes in a patient’s ocular condition. The test, however, should not be repeated if there has been no change in the ocular condition.
3. External ocular photography may be performed when it is medically necessary to document an ocular condition’s response to treatment.
In the absence of specific utilization guidelines, optometrists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of ophthalmic practice.