How To Use CPT Code 92228

CPT 92228 describes the imaging of the retina for the detection or monitoring of disease, with remote interpretation and report by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 92228?

CPT 92228 can be used to describe the imaging of the retina for the purpose of detecting or monitoring disease. This code specifically refers to cases where the imaging is performed in a location separate from the reviewing provider’s location. The images are then interpreted remotely by a physician or other qualified healthcare professional, who prepares a report based on their findings.

2. Official Description

The official description of CPT code 92228 is: ‘Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral.’

3. Procedure

1. The patient undergoes retinal imaging in a location other than where the reviewing provider is located.
2. The imaging system captures images of the retina using a wide-angle lens.
3. The images are then transmitted to a physician or other qualified healthcare professional for interpretation.
4. The interpreting provider reviews the images and prepares a report based on their findings.

4. Qualifying circumstances

CPT 92228 is used when retinal imaging is performed for the purpose of detecting or monitoring disease. It is important to note that this code should not be reported in conjunction with codes 92133, 92134, 92227, 92229, or 92250. These codes represent different procedures or interpretations that should not be billed together with CPT 92228.

5. When to use CPT code 92228

CPT code 92228 should be used when retinal imaging is performed to detect or monitor disease, and the interpretation and report are provided remotely by a physician or other qualified healthcare professional. This code is appropriate for both unilateral and bilateral imaging.

6. Documentation requirements

To support a claim for CPT 92228, the following documentation should be included:

• Reason for retinal imaging and the need for disease detection or monitoring
• Details of the imaging procedure, including the location where it was performed
• Date and time of the imaging procedure
• Images captured during the procedure
• Interpretation and findings of the reviewing physician or qualified healthcare professional
• Preparation of a report based on the interpretation

7. Billing guidelines

When billing for CPT 92228, ensure that the retinal imaging is performed in a location separate from the reviewing provider’s location. It is important to note that CPT 92228 should not be reported with codes 92133, 92134, 92227, 92229, or 92250. These codes represent different procedures or interpretations that should not be billed together with CPT 92228. Additionally, it is recommended to review the specific guidelines and requirements of the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 92228 was added to the Current Procedural Terminology system on January 1, 2011. The code was later updated on January 1, 2021, to specify its use for remote imaging for monitoring and management of active retinal disease, such as diabetic retinopathy, with physician review, interpretation, and report.

9. Examples

1. A patient undergoes retinal imaging in a separate location, and the images are remotely interpreted by a physician to monitor the progression of diabetic retinopathy.
2. A qualified healthcare professional reviews retinal images taken in a different location to detect any signs of macular degeneration in a patient.
3. Retinal imaging is performed on both eyes of a patient in a location separate from the interpreting physician, who provides a report on the presence of any retinal diseases.
4. A physician remotely interprets retinal images taken in another location to monitor the effectiveness of treatment for a patient with glaucoma.
5. A qualified healthcare professional reviews retinal images captured in a different location to detect any signs of retinal detachment in a patient.
6. Retinal imaging is performed on one eye of a patient in a separate location, and the interpreting physician provides a report on the presence of any retinal diseases.
7. A physician remotely interprets retinal images taken in another location to monitor the progression of age-related macular degeneration in a patient.
8. A qualified healthcare professional reviews retinal images captured in a different location to detect any signs of diabetic retinopathy in a patient.
9. Retinal imaging is performed on both eyes of a patient in a location separate from the interpreting physician, who provides a report on the presence of any retinal diseases.
10. A physician remotely interprets retinal images taken in another location to monitor the effectiveness of treatment for a patient with retinal vein occlusion.