Your latest purchase, a brand new optical coherence tomography angiography (OCTA) unit, just arrived at your office. The images are impressive. The details are like nothing you have seen from your current OCT. Your staff has been in-serviced on the equipment and now the administrator asks for guidance regarding the coding and billing of this new device. What do you say?
In this article, we discuss procedure coding for OCTA and explain why the current CPT code, 92134, suffices to report OCTA on a claim for reimbursement.
New Technology
Talisa de Carlo, MD, at New England Eye Center described OCTA as “a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds.”1 Some OCTA devices use high-speed spectral domain or swept-source technology to capture images, while other OCTA devices use split-spectrum amplitude-decorrelation angiography to detect movement in blood vessels.2
Analyzing motion within the retinal or choroidal blood vessels with OCTA creates images of vessels and capillaries, but does not require injection of dyes or a contrast medium. Historically, ophthalmic angiography required injection of fluorescein or indocyanine green dye.
Computed tomographic angiography in other parts of the body is performed with and without contrast material, so extending this approach to vessels in the eye is a welcome advancement. Several companies, including Optovue, Heidelberg Engineering, and Zeiss Medical Technology, currently offer OCTA.
Terminology
In the context of OCTA, is the term “angiography” appropriate? Taber’s Medical Dictionary defines angiography in two ways:3
A description of blood vessels and lymphatics.
Diagnostic or therapeutic radiography of the heart and blood vessels with a radiopaque contrast medium. Types include magnetic resonance angiography, interventional radiology and computed tomography.
Taber’s also describes intravenous fluorescein angiography as:
Fluorescein dye is injected into an arm vein and sequential photographs are taken of the fundus as the dye circulates at different time intervals
Broadly speaking, the term “angiography” is appropriate because OCTA captures images and, through additional analysis, creates detailed images of the blood vessels within the retina and choroid. Conversely, the historic use of this term by ophthalmic technicians, medical assistants and billing staff assumes that dye is injected.
Coding for OCTA
Because OCTA provides additional information about the retina and macula beyond traditional OCT, the question retina specialists often ask is, “Can I use another CPT code in addition to 92134 to describe the added utility of this service?” The code they sometimes suggest is 92499—“unlisted ophthalmological procedure or service.”
In the 2018 AMA CPT Professional Edition, the first occurrence of the term “angiography” in the section devoted to ophthalmology is 92235-—“Fluorescein angiography, with interpretation and report.” Next is 92240—”Indocyanine green angiography, with interpretation and report.”
However, neither code accurately describes OCTA; it uses neither fluorescein nor ICG dyes. CPT code 92134—“Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina”—describes OCT of the retina and associated structures (retinal layers, macula and retinal blood vessels).4 The February 2011 CPT Assistant discusses CPT 92134 as:
For the posterior segment, two distinct areas are imaged using the new technology, the optic nerve and the retina. The evaluation of the images differs. Consequently, codes 92133 and 92134 have been added to report scanning computerized ophthalmic diagnostic imaging of the optic nerve and retina, respectively ... Code 92134 describes scanning computerized ophthalmic diagnostic imaging of the retina.5
An example of current coverage guidance from Medicare Administrative Contractor National Government Services Local Coverage Determination defines scanning computerized ophthalmic diagnostic imaging (SCODI) (L34380) as:
• … a non-invasive, non-contact imaging technique. SCODI produces high-resolution, cross-sectional tomographic images of ocular structures and is used for the evaluation of anterior segment and posterior segment disease.
• SCODI also permits high-resolution assessment of the retinal and choroidal layers, the presence of thickening associated with retinal edema, and of macular thickness measurement.6
Considering these reliable sources, we conclude that 92134 should be used to report OCTA. The CPT description contains broad, inclusive language sufficient for this purpose. The omission of the term “angiography” from CPT 92134 does not mean the descriptor should be judged insufficient.
Because 92134 adequately describes OCTA, an additional CPT code is not necessary; it is duplicative. Use an unlisted code, such as 92499, only when a CPT code describing the service is not available.
And the Answer Is ...
To answer your administrator’s original question regarding the coding and billing of OCTA, your answer is this: CPT 92134 applies. While your administrator may be disappointed, OCTA represents an advance in the current ophthalmic imaging technology. It provides additional information, saves time and lowers the patient’s risk associated with intravenous injections of dye.
Within CPT, 92134 is broadly defined so it includes OCTA. The coverage indications listed in Medicare local coverage determination policies and by third-party payers for CPT 92134 apply to OCTA. Avoid adding CPT code 92499 to a claim for 92134, as it represents a billing error and may result in an overpayment.
No other CPT code is needed, and collecting additional payment from the patient is problematic for a host of reasons. With those words, enjoy your new technology, and code claims correctly. RS
Mr. Mack is a senior consultant with Corcoran Consulting Group. He can be reached at 1-800-399-6565 or at www.corcoranccg.com.
REFERENCES
1. de Carlo TE, Romano A, Waheed NK, Duker JS. A review of optical coherence tomography angiography (OCTA). Int J Retina Vit. 2015;1:5. eCollection.
2. Jia Y, Bailey ST, Hwang TS, et al. Quantitative optical coherence tomography of vascular abnormalities in the living eye. Proc Natl Acad Sci U S A. 2015;112:E2395-402.
3. Taber’s OnLine. Taber’s Medical Dictionary. Website: http://www.tabers.com/tabersonline/view/Tabers-Dictionary/744098/all/angiography#10. Accessed February 23, 2018.
4. 2018 AMA CPT Professional Edition. Chicago, IL; American Medical Association; 2016.
5. CPT Assistant. Ophthalmology Changes for 2011. Chicago, IL; American Medical Association; February 2011: 5.
6. Centers for Medicare & Medicaid Services. Local Coverage Determination: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L34380). https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34380. Accessed February 23,2018.
