Medical Billing

optomap is a retinal imaging tool which can be used for the early detection of disease or abnormalities in the posterior segment of the eye in the context of preventative medicine and eye health and wellness. optomap is differentiated from other diagnostic procedure and not covered by Medicare and most third party payers, so the patient is financially responsible for the service.   For more details, please review the FAQs PDF developed by the Corcoran Consulting Group.

optomap plus expands on the basic exam using additional capabilities in the image capture and review process to facilitate the diagnosis and management of previously detected ocular pathology.  This procedure is indicated for medically necessary testing.  The optomap plus  is considered fundus photography (CPT 92250) and may be reimbursed by Medicare and other third party payers according guidelines established for fundus photography.  For more details, please review the FAQsPDF developed by the Corcoran Consulting Group.

For complete reimbursement details, please review the Reimbursement monographPDF developed by the Corcoran Consulting Group.

November 2014 CPT Assistant

In November 2014 CPT Assistant, the authoritative source for guidance on use of CPT codes published by the American Medical Association, a question was asked about which CPT code to use when reporting fundus photography examinations taken using a scanning laser which produces a fundus photograph.  

The answer was “If the scanner produces an image of the retina or optic nerve along with other data and imaging for quantitative analysis, it would be appropriate to report a single service from the appropriate scanning computerized ophthalmic diagnostic imaging code range (92133-92134). If only an image is obtained, then code 92250 would be reported…It is important to note that if the only necessary service provided is generating a fundus photograph without the need to quantify the nerve fiber layer thickness and to analyze the data via a computer, then reporting code 92250 is appropriate, even if the photograph was taken with a scanning laser.” 

The optomap plus is considered fundus photography and may be reimbursed by Medicare and other third party payers according guidelines established for fundus photography (92250).  For more details, please review the FAQsPDF developed by the Corcoran Consulting Group or see CPT Assistant, November 2014.

October 2014 EyeNet - Savvy Coder

Read the special highlight section where the authors cover optomap coding for testing services.

Click image to enlarge
Medical coding and Billing Protocol

Medical coding and Billing Protocol

The optomap fa is considered fluorescein angiography and is performed to detect abnormalities of retinal blood vessels.  This procedure (CPT 92235) may be reimbursed by Medicare and other third party payers according guidelines established for fluorescein angiography.  For more details, please review the FAQsPDF developed by the Corcoran Consulting Group.

The optomap icg is considered indocyanine green angiography and is performed to detect abnormalities of retinal blood vessels.  This procedure (CPT 92240) may be reimbursed by Medicare and other third party payers according guidelines established for indocyanine green angiography.  For more details, please review the FAQsPDF developed by the Corcoran Consulting Group.

For complete reimbursement details, please review the Reimbursement monographPDF developed by the Corcoran Consulting Group.