and at the same patient encounter. Code has been deleted. For scanning computerized ophthalmic diagnostic imaging of optic nerve and retin

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Darrell Waters
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1 92227: Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral. For Medicare, bill only one charge and use the quantity "1" whether you do the test on one or both eyes. Do not use modifier 50 or bill separately with RT and LT modifiers. A. No, they cannot be billed at the same patient encounter, per CPT instructions. Most likely, an NCCI bundle for the two codes will be issued. All the new codes have the requirement of "interpretation and report." The article on my Web site ( titled "The Three C's: Interpretation and Report Requirements for Diagnostic Testing" and found under "Articles" outlines what you should be doing. New retinal ophthalmic diagnostic testing codes for A. The NCCI edits will appear either in version 17.0 (January 1, 2011) or version 17.1 (April 1, 2011). At this time, I think it is safe to assume that and will be bundled with : Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral. Do not report either or in conjunction with to 92014, 92133, 92134, 92250, or with the evaluation and management codes of the single-organ system, the eye, codes to Q. Please confirm that the would apply to an OCT of the optic nerve (99% sure that it is). "These codes are required to meet the needs of diabetic retinopathy screening programs, which provide remote imaging and data submission to a centralized reading center. Code is intended for reporting a screening examination for the asymptomatic patient at risk for diabetes mellitus-associated retinopathy. Code is intended for reporting remote imaging required for monitoring and management of patients with active retinal disease." : Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. Do not report and at the same patient encounter.

2 and at the same patient encounter. Code has been deleted. For scanning computerized ophthalmic diagnostic imaging of optic nerve and retina, see 92133, : Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. You can expect bundles of the above codes in the NCCI (National Correct Coding Initiative). Q. Will this be billable with fundus photography (CPT code 92250)? Q. Can and be used on the same visit? Riva Lee Asbell can be contacted at where the order form for her new book, Tips on Ophthalmic Surgical Coding by Subspecialty, can be found and downloaded under Products/Books. New Retinal Ophthalmic Diagnostic Testing Codes for Retinal Physician: Therapeutic and Surgical Treatment of the Posterior Segment delivers in-depth coverage of the latest advances in AMD, diabetic retinopathy, macular edema, retinal vein occlusion as well as surgical intervention in posterior segment care. It reaches both retinal specialists and general ophthalmologists with practical insight regarding current and future treatment strategies in medical and surgical retina care. The most comprehensive retinal care journal, Retinal Physician puts into perspective what the scientific developments mean to today's practice and discusses ramifications of new studies, treatments and patient management strategies. Published nine times per year. CPT code has been deleted for Three new codes are to be used for OCT. The new codes are for anterior segment, posterior segment, optic disc, and posterior segment, retina. Malignant neoplasm of overlapping sites of right eye and adnexa. Retinal disorders are the most common causes of severe and permanent vision loss. Scanning computerized ophthalmic diagnostic imaging (SCODI) is a valuable tool for the evaluation and treatment of patients with retinal disease, especially macular abnormalities. SCODI is able to detail the microscopic anatomy of the retina

3 detail the microscopic anatomy of the retina and the vitreo-retinal interface. SCODI is useful to measure the effectiveness of therapy, and in determining the need for ongoing therapy, or the safety of cessation of that therapy Ht muscle image spect mult - average fee payment - $500 - $510. Medicare claim address, phone numbers, payor id - revised list. SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; OPTIC NERVE. SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL. Open angle with borderline findings, high risk, bilateral. Benign neoplasm of right lacrimal gland and duct. Open angle with borderline findings, high risk, left eye. CPT CODE , , a4641. a9500, j Cardiovascular Nuclear Medicine. Calculation of lens power for cataract patients who have undergone prior refractive surgery. Payment will only be made for the cataract codes as long as additional documentation is available in the patient record of their prior refractive procedure. Payment will not be made in addition to A-scan or IOL master. Billing CPT 77080, 77081, with covered dx. Long Term Use of Chlorquine (CQ) and or Hydroxychloroquine (HCQ). Scanning computerized ophthalmic diagnostic imaging allows earlier detection of glaucoma and more sophisticated analysis for ongoing management. These tests also provide more precise methods of observation of the optic nerve head and can more accurately reveal subtle glaucomatous changes over the course of time than visual fields and/or disc photos. This allows earlier and more efficient efforts of treatment toward the disease process. Open angle with borderline findings, high risk, right eye. CPT codes 11042, 11043, 11044, 97597, Debridement tissue wound care. SCODI may be used to examine the structures in the anterior segment structures of the eye. However, it is still seen as experimental/investigational except in the

4 experimental/investigational except in the following: Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm o. Medicare will cover emergency ambulance services when the services are medically necessary, meet the desti. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,. CPT code 11400, 11401, and Excision benign lesion. Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye. Performing Fundus Photography and SCODI on the Same Day on the Same Eye: Fundus photography (CPT code 92250) and scanning ophthalmic computerized diagnostic imaging (CPT code or 92134) are generally mutually exclusive of one another in that a provider would use one technique or the other to evaluate fundal disease. However, there are a limited number of clinical conditions where both techniques are medically reasonable and necessary on the ipsilateral eye. In these situations, both CPT codes may be reported appending modifier 59 to CPT code (National Correct Coding Initiative Policy Manual, Chapter 11, Section G, Ophthalmology). a. Intraocular Photography to Diagnose Conditions listed below (CPT code 92250) Intraocular photography when used by an ophthalmologist is covered for the diagnosis of such conditions as macular degeneration, retinal neoplasms, choroid disturbances and diabetic retinopathy, or to identify glaucoma, multiple sclerosis and other central nervous system abnormalities. Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye. Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral. Diabetes mild nonproliferative diabetic retinopathy with macular edema, bilateral. Diabetes proliferative diabetic retinopathy with macular edema, unspecified eye. Contractors may specify Revenue Codes to

5 Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, Malignant neoplasm of unspecified site of left eye. - Fundus photography is considered medically reasonable and necessary when it is furnished by a qualified optometrist or ophthalmologist in the course of the evaluation and management of a retinal disorder or another condition that has affected the retina as outlined above. Therefore, the digital imaging systems for the detection and evaluation of diabetic retinopathy used to acquire retinal images through a dilated pupil with remote interpretation do not meet reasonableness and necessity criteria for fundus photography (CPT codes and 92228). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:. Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye. Diabetes proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye. Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient's condition or to improve the function of a malformed body member. Compliance with the provisions in this policy is subject to monitoring by postpayment data analysis and subsequent medical review. Fundus photography is not a covered service when used to document the absence of pathology (i.e., a normal or healthy fundus or screening) or when the physician elects to incorporate it as a routine procedure. Routine fundus photography for purposes

6 Routine fundus photography for purposes other than documentation, monitoring and treatment of a pathological process falls outside the standard of care as a medical necessity and is thereby not a covered service. Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye. Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye. Diabetes mild nonproliferative diabetic retinopathy with macular edema, right eye. Malignant neoplasm of overlapping sites of left eye and adnexa. Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye. Enter your zip code: Range: 10 miles Copyright 2003 Diagnosis All rights reserved.

Contractor Information

Contractor Information Local Coverage Determination (LCD): Scanning Computerized Ophthalmic Diagnostic Imaging (L35038) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor