Review of Optometry’s current Diagnostic Technology Survey reveals the new technology that optometrists have been buying in the last three years or are considering buying in the near future. However, employing this technology brings with it the implicit responsibility of understanding how to bill for it correctly. Keep in mind that for each and every test performed, you must comply with clearly establishing the medical necessity for the test in the medical record prior to doing the test.

That said, let’s review the billing for some of these technologies.

• Fundus photography with interpretation and report (92250). Digital fundus cameras are the most popular technology among the surveyed optometrists. It’s obvious how digital fundus photography can improve patient care … but how do we get paid?

Many of the rules for fundus photography vary from state to state, so check your local carrier or online resources, such as for the LCD (local coverage determination) to see if your state has any specific requirements.

Fundus photography is usually not covered merely to document the existence of a condition—it’s to be used as a baseline and to monitor change or confirm stability. The frequency of fundus photography should be determined by “medical necessity.” Some states allow it to document any patient with diabetes mellitus, whether or not they have diabetic retinopathy. Many do not.

This is a bilateral code, so you don’t need to use a -50 modifier or the -RT and -LT modifiers. You’ll be paid for both eyes when you list the 92250 CPT code. However, if you take a photo of just one eye, you must indicate it by using the -RT or -LT modifier and cut your fee by 50%.

• Scanning computerized ophthalmic diagnostic imaging (SCODI) with interpretation and report (92135). This is the CPT code for OCT and RTA technology. Scanning laser imaging analysis is generally provided annually during the progress of glaucoma, and as “medically necessary” for multiple macular/retinal abnormalities and monitoring high risk medications.

Unlike fundus photography, computerized diagnostic imaging is a unilateral procedure, which means that if you perform the imaging on both eyes, you must report that you performed the test twice. You can use one of two methods: You may use the -50 modifier, or use the -RT or -LT modifier to designate right and left eye.

I prefer using the -RT and -LT for a couple reasons. One, it’s easy to make two different codes in your billing software and just mark them both on your routing slip, which will create two line items on your claim. That way, you’re sure that you’re getting paid correctly for both eyes.

Secondly, by using -RT and -LT, it’s very clear to anyone in your office exactly which procedure you did, which eye(s) you evaluated, and exactly what procedure(s) you are billing for.

• Corneal topography (92025). This test is also close to the top of the list of most popular technology. There is a lot of variability on what diagnoses qualify for this procedure with private carriers, so monitor the different carriers to learn what each carrier feels are appropriate diagnoses. Corneal topography is defined by CPT as a unilateral or bilateral procedure and does not require using a modifier whether you do perform it on one eye or both.

Lastly, remember that any diagnostic testing that requires an interpretation and report should document the following:

• An order for the test
• The patient’s name and date of the test
• Indications for the test
• An interpretation of the results with a report
• Your signature

New technology is wonderful, and so is getting paid for it!

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