Expanding Role of Telemedicine in Diabetes Retinopathy Screening

1. www.outsourcestrategies.com

2. 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 www.outsourcestrategies.com

3. 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 www.outsourcestrategies.com

4. Reporting Teleretinal Screening for Appropriate Reimbursement The CPT codes to report teleretinal imaging for diabetic retinopathy are: www.outsourcestrategies.com

5. 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. www.outsourcestrategies.com

6. 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. www.outsourcestrategies.com

7. 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 www.outsourcestrategies.com

8. 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. www.outsourcestrategies.com

9. 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 www.outsourcestrategies.com

10. Ophthalmologists can rely on outsourced medical billing and coding services to report teleretinal DR screening accurately CONTACT US : Call us: (800) 670 2809 E-mail:sales@managedoutsource.com Headquarters:8596 E. 101st Street, Suite HTulsa, OK 74133Main: (800) 670 2809Fax: (877) 835-5442 Thank You! www.outsourcestrategies.com