MAR 15, 2022
What is proper coding for implementing diabetes teleretinopathy screening program?
My institution is implementing a diabetes teleretinopathy screening program. Our system will flag patients with diabetes who are not under the care of an ophthalmologist, and they will receive a nonmydriatic retinal photo in the PCP or endocrinologist's office performed by their staff. Images will be sent to our ophthalmology department for remote interpretation and a report with recommendations will be sent back to the PCP. What is the proper code to use: 92227 vs 92228? Does CMS require a prior authorization for this service?
92228 is the correct code for the interpretation and report; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral. The PCP office bill 92227 for taking the pictures; Imaging of retina for detection or monitoring; with remote clinical staff review and report, unilateral or bilateral.
Check your Medicare administrative contractor’s (MAC) local coverage article or private payer policy that outlines requirements for ophthalmoscopy and fundus photography (A56726), including CPTs 92227 and 92228. Prior authorization for Medicare patients is not required, but you will need to check with other payers.
for a list of all local coverage determination policies.