How To Use CPT Code 92273

CPT 92273 describes the electrophysiologic test of retinal function, specifically the full field or Ganzfeld electroretinography (ERG). 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 92273?

CPT 92273 can be used to describe the electrophysiologic test of retinal function, specifically the full field or Ganzfeld electroretinography (ERG). This test assesses the outer or generalized retinal function by recording the electrical activity generated by the retina in response to light flashes. It can detect abnormalities in the rods and cones, bipolar cells, and pigmented epithelium, providing valuable information about retinal health.

2. Official Description

The official description of CPT code 92273 is: ‘Electroretinography (ERG), with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG).’ This code encompasses the performance of the full field ERG test, interpretation of the results, and the preparation of a formal report documenting medical necessity and the impact on patient management and prognosis.

3. Procedure

1. The patient is dark adapted and their eyes are dilated to prepare for the test.
2. The provider instills a local anesthetic into the eyes and fits the patient with a recording contact lens and a reference electrode attached to the patient’s forehead.
3. Light flashes are produced, and the electrical activity generated by the retina is recorded.
4. The response is a waveform that resembles an electrocardiogram, with distinct components representing the rods and cones, bipolar cells, and pigmented epithelium.
5. The provider interprets the waveform and identifies any deviations that may indicate disease or abnormalities in the corresponding retinal components.
6. A formal report is prepared, documenting the test results, medical necessity, and the impact on patient management and prognosis.

4. Qualifying circumstances

CPT 92273 is performed on patients who require an assessment of their retinal function. This test is particularly useful when ophthalmoscopic examination is limited due to factors such as cataracts or corneal opacity. It can also be performed on babies. The test must be performed by a qualified provider and requires the patient to be dark adapted and have dilated eyes. The provider must document medical necessity and explain how the test results will affect the patient’s management and prognosis.

5. When to use CPT code 92273

CPT code 92273 should be used when performing the full field or Ganzfeld ERG test to assess retinal function. It is appropriate when there is a need to evaluate the outer or generalized retinal function, and when the test results will impact the patient’s management and prognosis. This code should not be used for other types of ERG tests, such as focal ERG or multifocal ERG, which have their own specific codes (92274 for multifocal ERG).

6. Documentation requirements

To support a claim for CPT 92273, the provider must document the following information:

• Medical necessity for the test
• Details of the test performed, including the type (full field or Ganzfeld ERG)
• Results of the test, including any deviations from normal waveforms
• Interpretation of the results
• Preparation of a formal report documenting the impact on patient management and prognosis

7. Billing guidelines

When billing for CPT 92273, ensure that the test performed is the full field or Ganzfeld ERG. The provider should also include the interpretation and report in the billing. It is important to check with the payer’s local coverage decision (LCD) for any specific requirements or preauthorization requirements for this test. CPT code 92273 should not be reported with other ERG codes, such as 92274 for multifocal ERG.

8. Historical information

CPT 92273 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a full field ERG test to assess their retinal function and detect any abnormalities in the rods and cones, bipolar cells, or pigmented epithelium.
2. A provider performs a Ganzfeld ERG on a patient with corneal opacity, as ophthalmoscopic examination is limited in this case.
3. A baby undergoes a full field ERG to evaluate their retinal function and detect any potential abnormalities.
4. A patient with suspected retinal disease undergoes a full field ERG to assess the health of their retinal components.
5. A provider performs a Ganzfeld ERG on a patient with cataracts, as ophthalmoscopic examination is limited in this case.
6. A patient with a history of retinal disease undergoes a full field ERG to monitor the progression of their condition and guide their management.
7. A provider performs a Ganzfeld ERG on a patient with suspected abnormalities in their retinal function, aiming to identify the specific retinal components affected.
8. A patient with a family history of retinal disease undergoes a full field ERG to assess their own retinal function and detect any potential abnormalities.
9. A provider performs a Ganzfeld ERG on a patient with a history of retinal detachment, aiming to evaluate the health of their retinal components.