CPT 92285, cpt code 92285, 92285 cpt code

CPT Code 92285 | External Ocular Photography | Description & Billing Guide

CPT code 92285 refers to performing services for external ocular imaging with interpretation and report for documenting medical progress. Exterior visual photography is a non-invasive method. Below the description and billing guidelines for CPT 92285.

What Is CPT 92285?

Use CPT code 92285 to describe a procedure for capturing images of the outer structures of the eye. As an alternative, external photographic methods document the state of the anterior segment of the eye.

Some examples include the eye’s frontal structures like the iris, cornea, and lens and the crystalline lens and filtration angle.

For external ocular photography, physicians use various tools, including a hand-held close-up camera, a camera with an integrated slit light, a photography lens, or a close-up stereo camera. Completed pictures are archived in digital formats, such as prints, slides, or videotapes.

Taking photographs at regular intervals can help monitor the effectiveness of a treatment plan for an eye condition or determine whether or not the situation has improved over time. However, although photographs of many eye conditions are possible, they do not document the presence of a problem. 

Where Is External Ocular Photography Used For?

External Ocular Photography is used to demonstrate how abnormalities in the extra-ocular muscles, or other diseases, have caused the eyes to be misaligned. It should be uncommon to record still images and moving videos of these eye movement disorders.

External Ocular photography classifies an accidental examination component; photographs taken to document disease are not individually compensated. 

Several Medicare contractors have included a clause indicating that this treatment is not utilized to verify the existence of a problem to enrich the medical record” in local policies. 

It should be essential to calculate benefits before delivering care that cannot be covered by Medicare Part C (Medicare Advantage). MA Plans cannot be used in the Medicare ABN form; instead, their waiver processes should be used, which may differ from Medicare’s. Repeated testing cannot be subjected to any declared restrictions.

92285 CPT Code Description

The specialized ophthalmological services and procedures section of the American Medical Association’s code list includes CPT code 92285.

CPT 92285 is described by CPT’s manual as: “External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography).”

External ocular imaging is subject to the medicare multiple procedure payment reductions.

Therefore, when numerous exams are scheduled for the same day, students can be used this code to give less time to complete the technical requirements of the exam with the lowest value. 

CPT code 92285 can be used as a straightforward method of documenting the eye’s external anatomy (such as the conjunctiva, cornea, sclera, and eyelids).

In addition, information regarding the filtration angle, cornea, iris, and posterior chamber of the eye can be obtained through external imaging.

Ophthalmic photographers use the term “external photography” to describe images of the eye captured by standard cameras. To the untrained eye, the images obtained by both fundus and slit lamp cameras of the “external” (rather than interior) eye look very similar.

The usual range of subjects for exterior photography should be from a low-power image of the face to a high-power appearance of a single eye.

General ophthalmologists and ophthalmic-plastic surgeons use photos of the outside of a patient’s face to identify skin types, lesions, and morphological anomalies of the skull, eyelids, and surrounding areas. 

Using film or digital media, external or slit lamp photography, or still or moving images makes no difference in the application of CPT code 92285. 

Physicians use the following for exterior ocular photography:

  • A hand-held close-up camera
  •  A camera with an integrated slit light

Digital prints, slides, and videotapes archive the final images.

Billing Guidelines

Ocular photography can be performed on the same date of service on the same eye to be mutually exclusive and hence prohibited.

Medically necessary photos cover the correct use of CPT code 92285. Some of them are given below.

  • Offer additional details that can not be learned via the test
  • Assist in disease or condition diagnosis and treatment
  • Investigations can be used to help determine how the disease is progressing.

Color photographs should be required to prove the medical necessity of upper eyelid surgery. Pictures of the relevant structures should be extensive and detailed enough to make the structures visible, and they must faithfully portray the “physical indications” that were recorded. 

The patient’s head should be horizontal to the camera’s axis so as not to distort the appearance of any important finding (e.g., a downward head tilt might artificially reduce the apparent measurement of an MRD). Both film and digital camera photos should be welcome. Images can be included the recipient’s full name and birth date.

Note that although performing and correctly documenting billable ophthalmic tests frequently, Medicare should not be finished the process by invoicing the patient or the patient’s medical insurer for the testing.

The classification of some procedures as bilateral or unilateral also causes some difficulty. Both eyes can be treated during a bilateral treatment, although only one charge is made.

Medicare Coverage

According to Medicare utilization statistics for claims paid, ophthalmologists can be performed external photography at 0.8% of all office visits. In other words, Medicare compensated for this service eight times for every 1,000 exams and consultations done on beneficiaries of the Medicare program. Similar utilization rates can be applied to optometry.

Does CPT Code 92285 Need A Modifier?

No. No modifier should be used for CPT code 92285 if the test is administered the same day.

Bill the CPT code 92012 and the 92285 without any further modifiers.

Only procedures like removing foreign bodies or similar ones require a modifier; tests like visual fields, OCT, or photographs do not need a modifier.

Reimbursement

CPT code 92285 covers both eyes for reimbursement purposes. In 2017, the Medicare Part B physician fee schedule in CPT code 92285 was $21.17.

Changes to Medicare-approved costs should be made at the regional level, based on local wage indexes. Comparatively, Medicare’s publicized fee schedule should be much different from the rates set by other payers.

Example

A patient whose age is 25 years old visited the clinic of the optical surgeon. After routinely sleeping in a soft contact lens that is not intended for extended wear, a long-term patient complains of a red, irritated right eye.

The patient’s core complaint of the red, sore eye can be supported by a thorough history, an enlarged problem-focused examination, and somewhat complicated decision-making that are all properly recorded in the medical record.

The 92285 CPT code is billed in this case.

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