CODING Q & A

Resolving the Coding Dilemmas Related to Remote Imaging

Information Provided By Riva Lee Asbell

Two new codes were included in CPT for 2011 regarding coding and reimbursement by remote imaging. This review will clarify the appropriate uses of them.

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.

(Do not report code 92227 in conjunction with 92002-92014, 92133, 92134, 92250, 92228 or with the evaluation management of the single organ system, the eye, 99201-99350).

92228: 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 code 92228 in conjunction with 92002-92014, 92133, 92134, 92250, 92227 or with the evaluation management of the single organ system, the eye, 99201-99350).

The Rationale. The codes were established to provide a reporting mechanism for remote imaging for (1) screening for retinal disease and (2) management of active retinal disease. They were developed to meet the needs of diabetic retinopathy screening programs. Those of you involved with the ETDRS are familiar with the concept.

Remote screening imaging, used throughout the world, has been shown to promote earlier diagnosis for patients who otherwise may have suffered from a lack of diagnosis and subsequent treatment. This approach increases the num ber of patients actually screened for DR, something that differs from using fundus photography (CPT code 92250).

Fundus photography requires an ophthalmic diagnosis for documentation of the disease in the retina practice in order to be paid by Medicare, whereas a screening code does not. You cannot per form screenings for retinal disease using fundus photography and bill Medicare.

Advice from CPT Changes: An Insider's View. This AMA publication offers the following advice:

“Code 92227 is intended for reporting screening examination for the asymptomatic patient at risk for a condition such as diabetes mellitus associated retinopathy. Code 92228 is in tend ed for re porting remote imaging requirement for monitoring and management of patients with active retinal disease. The work of actually providing the remote imaging services for detection of retinal disease (92227) does not require a physician, whereas the work to review the images for the patient with actual disease (92228) requires physician review, interpretation, and report.”

Examples are given as follows:
Typical Patient (92227). The AMA book mentions a 57-year-old male with a seven-year history of diabetes controlled with oral hypoglycemic agents, no specific visual complaints and no eye exam within the last year. The patient is referred for retinal screening imaging.

Typical Patient (92228). For this code, the example given is a 35-year-old female with an 11-year history of diabetes, controlled with insulin, and a known history of diabetic retinopathy.

Description of Procedure (92228). In this example, the practice obtains retinal photos of each eye. The images are forwarded to the reading center, where a physician reviews them. An interpretation is prepared by a physician and report sent to the referring provider.

Comparisons and Intent. The physician work and practice expenses of these procedures are different from current CPT terminology for onsite imaging services. The codes cannot be performed at the same time as an office visit, which differs from the rules for fundus photography.

Remote imaging (92228) is typically performed under the supervision of the interpreting/managing physician. The test is performed in an office or facility able to provide remote imaging and data submission to a centralized reading center. Only the reading center is reimbursed for 92227. RP

All CPT codes and content from CPT Changes: An Insider's View copyright 2011 by the American Medical Association.