Expanding Role of Telemedicine in Diabetes Retinopathy Screening

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Expanding Role of Telemedicine in Diabetes
Retinopathy Screening

• Diabetic retinopathy (DR) is a common
  complication associated with diabetes
• Over 60 of patients with type 2 diabetes develop
  DR within the first two decades after the initial
  diabetes diagnosis
• Researchers say that primary care based
  telemedicine is a feasible option to detect DR
  early in patients with diabetes in primary care
  settings
• Demand for DR screening is set to increase with
  rising incidence of Type 2 diabetes, even among
  younger populations

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Benefits of Primary Care-based Teleretinal
Diabetes Retinopathy Screening (TDRS)

• TDRS can identify patients who are at greatest
  risk for vision loss
• Telemedicine optimizes the utilization of
  in-person evaluations
• It is cost-effective
• It benefits people in the rural areas where the
  availability of eye care providers is limited
• It helps eliminate socioeconomic barriers to care

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Reporting Teleretinal Screening for Appropriate
Reimbursement

• The CPT codes to report teleretinal imaging for
  diabetic retinopathy are

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Reporting Teleretinal Screening for Appropriate
Reimbursement

• The CPT codes to report teleretinal imaging for
  diabetic retinopathy are

Only one of these 3 codes should be used to
denote a service.
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Medicare Coverage Guidelines for Use of Remote
Imaging CPT codes for DR

• Fundus photography is considered medically
  necessary only when it would assist in
• - monitoring potential progression of a disease
  process or
• - providing guidance in evaluating the need for
  or response to a specific treatment or
  intervention.
• 92227 and 92228 should not be reported in
  conjunction with 92002-92014, 92133, 92134,
  92250 or with the E/M of the single system organ
  system, the eye, 99201-99350.

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Medicare Coverage Guidelines for Use of Remote
Imaging CPT codes for DR

• 92250 and 92228 - global services, which include
  a professional and a technical component (TC).
  The components should be reported with modifiers
  26 or TC
• 92250 and 92228 - services that are performed
  bilaterally do not use modifier 50 Bilateral
  Procedures with these codes unilateral services
  require use of modifiers LT and RT
• Modifier 52, Reduced/Eliminated Services
  indicates unilateral service and modifiers RT
  and LT are not required
• Modifier 59 - use for distinct procedural service

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Medicare Coverage Guidelines for Use of Remote
Imaging CPT codes for DR

• Modifier GY - submit with claims for CPT code
  92227 (Remote imaging for detection of retinal
  disease (e.g., retinopathy in a patient with
  diabetes) with analysis and report under
  physician supervision, (unilateral or bilateral)
• TC Add modifier 'TC' to the usual procedure
  number when charge is made for the technical
  component alone TC charges are institutional
  charges
• XU Distinct service modifier XU is reported to
  indicate the use of a service that is distinct
  because it does not overlap usual components of
  the main service.

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Additional reimbursement considerations for
TDRS claims

• Who owns the camera
• Where the camera is physically located
• Who employs the assistants or technicians taking
  the photographs
• Diagnostic report should include retinal images
  and contain all relevant ICD codes

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Ophthalmologists can rely on outsourced medical
billing and coding services to report teleretinal
DR screening accurately
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