92250

Fundus photography with interpretation and report

Fundus photography (also known as retinal photography) is a diagnostic imaging procedure used to document the appearance of the optic disc, macula, posterior pole, and peripheral retina. It involves capturing high-resolution images of the interior surface of the eye, specifically the fundus, which includes the retina, optic disc, macula, and fovea. These images aid in the diagnosis, documentation, and monitoring of various retinal and optic nerve conditions. The code includes the technical component of acquiring the images and the professional component of the physician's interpretation and generation of a written report.

Clinical Indications

  • Diabetic retinopathy (screening, progression monitoring, pre-treatment assessment)
  • Glaucoma (optic disc evaluation, nerve fiber layer assessment, progression monitoring)
  • Macular degeneration (age-related macular degeneration - AMD, other maculopathies)
  • Retinal vascular occlusions (retinal artery or vein occlusion)
  • Hypertensive retinopathy
  • Retinal detachment or tears (documentation of extent)
  • Optic nerve disorders (e.g., papilledema, optic neuritis, optic atrophy)
  • Choroidal neovascularization
  • Retinal dystrophies and degenerations
  • Intraocular tumors or lesions (e.g., choroidal nevus, melanoma)
  • Monitoring of medication-related ocular toxicity (e.g., Plaquenil retinopathy)

Procedure Steps

  1. Patient education regarding the procedure.
  2. Pupil dilation using mydriatic eye drops (if necessary, though widefield imaging may not always require it).
  3. Positioning the patient at the fundus camera.
  4. Capturing a series of digital photographs of the fundus, typically including stereo views of the optic nerve head and macula.
  5. Reviewing image quality and acquiring additional views as needed.
  6. Transferring images for storage and physician review.
  7. Physician interpretation of the fundus photographs, comparing them to previous images if available.
  8. Preparation of a written report detailing findings, interpretation, and clinical correlation.

Coding Guidelines

  • CPT code 92250 is considered a bilateral procedure when performed on both eyes. It is reported once, regardless of whether one or both eyes are photographed.
  • The code includes both the technical component (image acquisition) and the professional component (interpretation and report). If only one component is performed, modifiers -26 (professional component) or -TC (technical component) should be appended.
  • Documentation must include the medical necessity for the procedure, the images obtained, the physician's written interpretation, and a report outlining findings and assessment.
  • This code should not be reported with ophthalmoscopy codes (e.g., 92201, 92202, 92002, 92004, 92012, 92014) if fundus photography is performed on the same day for the same indications, as the photography includes examination of the fundus. However, if a general ophthalmoscopy is performed for a different clinical reason (e.g., a routine exam), it may be separately billable with appropriate modifiers.
  • Fundus photography is typically considered separately from an Evaluation and Management (E/M) service if it contributes to the medical decision making for a new or established problem.
  • Do not bill 92250 if only external ocular photography (e.g., for eyelids or anterior segment) is performed; use 92285 for external ocular photography.
  • It is generally considered inappropriate to bill 92250 for routine screening in asymptomatic patients without specific risk factors or clinical indications.

Associated ICD-10 Codes