There are 4 posts in this topic by 3 people.
| over 2 years ago | I was just curious about what everybody thinks concerning routine fundus photography. I would like to know how often most of you are doing fundus photos. And on a yearly basis or how often? Do you only do photos if there is a reason? i.e. glaucoma suspect, retinal lesion, diabetes, etc. I normally only do photos if there is a particular thing that I feel need documentation. Suspicious disks, nevi, vascular anomalies, etc. Not ever as a routine documentation of a normal eye. And do you bill it differently if you do take photos of “normal” eyes? Like charge the patient vs. insurance? I just wanted to know what the consensus was on this. Thanks. |
| over 2 years ago | As I currently don’t have a camera in the office, this is more an academic discussion for me, but I usually had one at hand. From a strictly medical billing standpoint, you can only bill for photos (CPT 92250) in the presence of appropriate pathology (CIGNA Medicare has, somewhere, a list of “appropriate” diag. codes). However, BCBSNC pays for “routine” photos in the context of a routine eye exam (same 92250 code!). I tend to agree with your approach of only documenting when there is something. One can start quite a philosophical discussion about the value of documenting normal in case there is ever future pathology, assuming that a sufficient percentage of patients ever develop pathology and that they see no other eye doctor than you for the next 25 years (hmmm, long shot). This is probably why most carriers don’t pay unless there is pathology. Now, many offices offer routine photos and “sell” it by making those points I mentioned. Those with an Optomap sell it as an alternative to dilation and say it is more sensitive at detecting some things (I worked with one for 2 years, and I can only lukewarmly agree with those points). In spite of the arguments made in favor of routine photos, it tends to be more of a profit center than anything else. Does that make routine photos inherently evil? I don’t know. |
| over 2 years ago | Hey Rich and Micheal! Glad to hear from you all on this site. I’ll add my two cents on fundus photography. I don’t do it because I don’t have one. Simple enough. That being said, if I had one, I wouldn’t do one on routine patients without pathology. Yes, I know there is a loophole (that BCBS will eventually close), but that doesn’t justify doing it. Currently, if they have retinal pathology of note, I document it with extended ophthalmoscopy drawings in accordance with Medicare guidelines. If I feel it needs more than that, then its on to the retinal folks. If the attitude is to do baseline testing on normal folks in order to document change over time, then we should also be doing pachmetry and corneal topography and macular thickness, etc.., BUT… the don’t pay as well or as easily without great documentation….HHMMM….the idea of a “profit center” needs to be well balanced with the best interest of the patient and the risks of audits. Now, younger patients might like the idea of new technology and getting to see their retinas on a computer screen (assuming digital photos) especially if they can avoid dilation, hence the OPTOMAP…which I agree with Richard…so-so sensitivity and helpfulness…that’s enough rambling for now…Sean Smolenyak, Raleigh NC |
| over 2 years ago | Hi Sean, good to hear from you! Actually, I’d like to buy a camera at some point, but recent events make the expenditure difficult. I know I should have a pachymeter, but it’s just so hard to part with $2700 knowing I’ll get $11 a pop, and you don’t get to justify its use that often. The one thing I learned about the Optomap (other than the $$$ dynamics don’t work too well) is that unless you have phenomenal techs who are very smart, and unless all your patients have a little exophthalmos, you’ll have a problem seeing parts of the retina easily seen with a 30D lens and a Keeler All-pupil even without dilation. I remember becoming a person I didn’t like when I was selling it all day to make the numbers work. -Rich Langellotti |