How To Use CPT Code 92242

CPT 92242 describes the procedure of fluorescein angiography and indocyanine-green angiography performed at the same patient encounter with interpretation and report, either unilaterally or bilaterally. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 92242?

CPT 92242 can be used to describe the combined procedure of fluorescein angiography and indocyanine-green angiography performed during the same patient encounter. This code is used when a healthcare provider injects two different special dyes into one or both eyes to capture photographic images of the blood vessels. The provider then interprets the findings and prepares a report based on the images obtained.

2. Official Description

The official description of CPT code 92242 is: ‘Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral.’

3. Procedure

1. After appropriate preparation and anesthesia, the healthcare provider injects fluorescein dye into a patient’s vein.
2. The fluorescein dye emits light when exposed to a specific wavelength, allowing the provider to capture multiple images of the blood flow in the small vessels of the eye.
3. The provider then injects a second fluorescent dye, indocyanine-green, which provides better images of the tiny vessels in the choroid at the back of the eye.
4. During the procedure, the provider captures multiple images using multiframe timing to examine the structure of the retinal blood vessels and detect any leaks.
5. After the procedure, the provider interprets the images and prepares a report summarizing the findings, comparing them to any previous studies, and documenting the impact on clinical management or prognosis.

4. Qualifying circumstances

CPT 92242 is performed when there are indications of disorders of the eye vessels and optic nerve, tumors, or when preparation for certain forms of laser treatment is required. The procedure involves injecting two different dyes into the eyes to capture images of the blood vessels. It is important to note that this code is only used when both fluorescein angiography and indocyanine-green angiography are performed during the same patient encounter.

5. When to use CPT code 92242

CPT code 92242 should be used when a healthcare provider performs both fluorescein angiography and indocyanine-green angiography during the same patient encounter. It is important to note that this code should not be reported if the procedures are performed at separate patient encounters. To report these procedures when they are not performed together, refer to CPT codes 92235 for fluorescein angiography and 92240 for indocyanine-green angiography.

6. Documentation requirements

To support a claim for CPT 92242, the healthcare provider must document the following information:

• Indication for the study, such as disorders of the eye vessels, optic nerve, tumors, or preparation for laser treatment
• Injection of fluorescein dye and indocyanine-green dye
• Date and details of the procedure, including whether it was performed unilaterally or bilaterally
• Images captured during the procedure
• Interpretation of the images and findings
• Comparison to any previous studies
• Impact on clinical management or prognosis

7. Billing guidelines

When billing for CPT 92242, ensure that both fluorescein angiography and indocyanine-green angiography are performed during the same patient encounter. Do not report these procedures separately. It is important to check with the payer regarding their policies on this study, as some may consider it investigational for certain indications. Additionally, refer to CPT codes 92235 and 92240 if the procedures are performed at separate patient encounters.

8. Historical information

CPT 92242 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with suspected retinal vascular disorder. The healthcare provider performs fluorescein angiography and indocyanine-green angiography during the same patient encounter to capture images of the blood vessels and assess the condition.
2. A patient requires preparation for laser treatment of an eye tumor. The healthcare provider performs both fluorescein angiography and indocyanine-green angiography to evaluate the tumor and plan the treatment.
3. A patient with optic nerve abnormalities undergoes both fluorescein angiography and indocyanine-green angiography to assess the extent of the condition and determine appropriate management.
4. A patient with a history of retinal vascular disease requires a follow-up examination. The healthcare provider performs both fluorescein angiography and indocyanine-green angiography to compare the current findings with previous studies and monitor the progression of the disease.
5. A patient presents with symptoms of choroidal neovascularization. The healthcare provider performs both fluorescein angiography and indocyanine-green angiography to evaluate the condition and guide treatment decisions.
6. A patient with a suspected retinal tumor undergoes both fluorescein angiography and indocyanine-green angiography to assess the tumor’s characteristics and plan further interventions.
7. A patient with a history of retinal detachment requires a comprehensive evaluation. The healthcare provider performs both fluorescein angiography and indocyanine-green angiography to assess the retinal blood vessels and detect any abnormalities.
8. A patient with diabetic retinopathy undergoes both fluorescein angiography and indocyanine-green angiography to evaluate the extent of the disease and determine appropriate treatment options.