92235

Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral

Fluorescein angiography (CPT 92235) is an essential diagnostic imaging modality used in ophthalmology to evaluate the vascular structures of the retina and choroid. This procedure involves the intravenous administration of sodium fluorescein dye, typically injected into an antecubital vein, followed by rapid-sequence multiframe imaging of the posterior segment of the eye. As the dye circulates through the ophthalmic artery and enters the choroidal and retinal circulations, a specialized fundus camera equipped with highly specific excitation and barrier filters is used to capture the transit of the fluorescence. The excitation filter emits blue light to excite the unbound fluorescein molecules, causing them to emit a yellow-green light, which is subsequently isolated by the barrier filter for image capture. The resulting angiogram is analyzed through distinct dynamic phases: the choroidal flush, the arterial phase, the arteriovenous (capillary) phase, the venous phase, and the late recirculation phase. By observing these phases, physicians can identify a wide array of pathological vascular changes. Normal retinal vessels are impermeable to fluorescein due to the inner blood-retinal barrier (tight junctions of the retinal capillary endothelium) and the outer blood-retinal barrier (retinal pigment epithelium). Therefore, any leakage of dye (hyperfluorescence) typically indicates a breakdown of these barriers, often seen in conditions such as diabetic macular edema, choroidal neovascularization secondary to age-related macular degeneration (AMD), or retinal vein occlusions. Conversely, areas of non-perfusion or blockage (hypofluorescence) can denote capillary drop-out, ischemia, or masking by overlying blood or pigment. The CPT code 92235 encompasses the entire procedure, including the multiframe imaging, the intravenous injection of the contrast agent, and the formal interpretation and report by the physician. Following a recent CPT update, this code is defined as inherently unilateral or bilateral, meaning it is reported only once per session, regardless of whether one or both eyes are imaged. A formal interpretation and report documenting the transit times, areas of normal and abnormal fluorescence, and clinical correlation is strictly required to fulfill the documentation standards for this procedure.

Clinical Indications

  • Diabetic retinopathy (proliferative and non-proliferative)
  • Clinically significant diabetic macular edema (CSME)
  • Exudative (wet) age-related macular degeneration (AMD)
  • Central or branch retinal vein occlusion (CRVO/BRVO)
  • Central or branch retinal artery occlusion (CRAO/BRAO)
  • Retinal vasculitis and posterior uveitis
  • Central serous chorioretinopathy (CSCR)
  • Macular pucker or Epiretinal membrane with suspected tractional edema
  • Intraocular tumors such as choroidal melanoma

Procedure Steps

  1. Obtain informed consent and confirm the patient has no history of severe fluorescein allergy.
  2. Dilate the patient's pupils using topical mydriatic drops.
  3. Position the patient comfortably at the specialized fundus camera.
  4. Establish intravenous access, typically in an antecubital or hand vein.
  5. Inject 2 to 5 mL of 10 percent or 25 percent sodium fluorescein dye as a rapid intravenous bolus.
  6. Initiate rapid-sequence multiframe photography using blue excitation light and yellow-green barrier filters, capturing all transit phases.
  7. Monitor the patient for adverse reactions to the dye, such as nausea, vomiting, or anaphylaxis.
  8. Review the generated multiframe images to identify hyperfluorescence, hypofluorescence, leakage, or ischemia.
  9. Generate a formal, written interpretation and report detailing the findings, diagnosis, and treatment plan.

Coding Guidelines

  • Code 92235 is reported once per session, regardless of whether imaging is performed on one or both eyes (unilateral or bilateral).
  • Do not report 92235 with modifiers LT, RT, or 50, as the CPT descriptor inherently includes unilateral or bilateral imaging.
  • A formal, distinct written interpretation and report must be maintained in the patient's medical record. Simply stating the procedure was performed is insufficient.
  • The injection of the fluorescein dye is bundled into the procedure and should not be reported separately (e.g., do not report 36000 or 96374 for the IV injection).
  • The cost of the sodium fluorescein dye may be reported separately (e.g., J2150) if performed in a non-facility or office setting, depending on individual payer policy.
  • Do not report 92235 in conjunction with indocyanine-green angiography (92240) unless medically necessary. If both are performed simultaneously, use the combination code 92242.

Associated ICD-10 Codes