Retinal exams are more accessible than ever to primary care practices
Beginning Jan. 1, your primary care customers have a green light from Medicare to conduct retinal exams in their office. In doing so, they can improve patient-satisfaction and quality-of-care (HEDIS) indicators, bolster practice revenues, and most important, help their patients avoid a serious eye-related condition – diabetic retinopathy. And Repertoire readers can help by offering Hillrom’s new handheld retinal camera – the Welch Allyn® RetinaVue® 700 Imager and RetinaVue® care delivery model.
Most commercial health plans (and Medicare Advantage plans) have covered teleretinal exams in primary care settings for years, explains Thomas Grant, Director of Marketing, Vision Screening and Diagnostics at Hillrom. “The gap has been Medicare fee-for-service.” No longer.
The American Medical Association (AMA) has updated CPT® Code descriptions for retinal imaging codes 92227 and 92228 to specify retinal exams performed in primary care settings with remote interpretation. This is important, because Medicare fee-for-service covers about 30% of the patient population.
It’s also important because of the fact that an estimated 80% of patients living with diabetes will eventually develop diabetic retinopathy.
What is diabetic retinopathy?
The retina detects light and converts it to signals sent through the optic nerve to the brain. Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina. Those blood vessels can leak fluid or hemorrhage, distorting vision. In its most advanced stage, new abnormal blood vessels proliferate on the surface of the retina, which can lead to scarring and cell loss in the retina. Severe visual impairment and blindness can result.
Diabetic retinopathy often starts with no symptoms, leading individuals with diabetes to fail to attend routine appointments with an eye care provider. (It is estimated that 50% or less of patients with diabetes comply with annual retinal exams.) Unfortunately, once vision loss occurs, it is often too late to reverse its progression. However, 95% of vision loss due to diabetic retinopathy can be prevented with early detection and treatment.
Teleretinal imaging
Teleretinal imaging programs allow primary care providers to capture an image of the patient’s retina during a routine appointment using a specialized camera. The retinal images are uploaded and transmitted to a remote eye specialist, who provides a diagnosis to the initiating facility. Patients with signs of diabetic retinopathy are referred for further care with an ophthalmologist.
Care Delivery Model
Hillrom’s RetinaVue® Care Delivery Model comprises three components:
- Welch Allyn® RetinaVue® 700 Imager
- Welch Allyn® RetinaVue® Network Software
- Interpretation by board-certified ophthalmologists and retina specialists through RetinaVue,® P.C.
A simple and affordable handheld camera designed for primary care, RetinaVue® 700 Imager captures images automatically with image quality similar to more-expensive tabletop cameras used by eye specialists. The camera offers an automated retina imaging experience, featuring auto-alignment, auto-focus and auto-capture, so minimal technique is required by the user. In fact, a study involving 35 registered nurses, licensed practical nurses and medical assistants showed that after a 30-minute practice session, all participants were able to capture a high-quality retinal image of each eye within three attempts.
In addition, the RetinaVue® 700 Imager can capture clear images through pupils as small as 2.5 mm, dramatically decreasing the need for dilating drops. And image capture can be completed in minutes, with minimal disruption to busy clinic workflow.
RetinaVue® Network Software offers secure transfer of encrypted retinal images and management of exam data via HIPAA-compliant, SOC 2 Type II certified, FDA-cleared software. Providers can meet their workflow and administrative needs, including population health management and quality reporting tools, to more effectively manage retinal exam data. To streamline documentation, fully integrated, bi-directional interfaces with EMRs, including Allscripts, athenahealth, Cerner, Epic, NextGen and many others, are offered. Physicians may place retinal exam orders and automatically access diagnostic reports from the EMR.
Through RetinaVue,® P.C., board-certified, state-licensed ophthalmologists and retina specialists interpret retinal images and prepare a comprehensive diagnostic report and referral/care plan generally in one business day, complete with ICD codes, signature, and license number. It is the first tele-ophthalmology provider to earn The Joint Commission’s Gold Seal of Approval® by demonstrating continuous compliance with its Ambulatory Care Accreditation Standards.
Learn more
The convenience and quality of the RetinaVue® Care Delivery Model, plus the coverage changes from Medicare, make access to recommended annual diabetic eye exams convenient for patients and primary care practices alike. Find out more by talking to your local Hillrom representative or visit www.RetinaVue.com.
Sidebar 1
What you should know about CPT® Code updates
Recent updates to CPT® Code descriptions for diabetic retinal imaging are designed to more accurately indicate where the exam is performed and how the exam is interpreted. These changes ensure CMS coverage for diabetic retinal exams in primary care settings.
- AMA has updated CPT® Code descriptions for retinal imaging codes 92227 and 92228 to specify retinal exams performed in primary care settings with remote interpretation.
- The description for CPT® Code 92250 remains unchanged, but the AMA has clarified that this code is intended for exams performed in the same place where the interpretation is performed (e.g., in an ophthalmologist’s office).
- The appropriate CPT® Code for teleretinal programs with physician overread will be 92228 beginning January 1, 2021 with CMS coverage currently proposed at $28.71 per exam (final rates will be published in December) – an improvement over no national coverage policy.
- Although there is always downward pressure on reimbursement rates, expect commercial coverage rates to remain somewhat stable (approx. $70 on average) for the diabetic retinal exam in primary care settings – ensuring primary care providers are incentivized to continue efforts to close the HEDIS quality gap.
Sidebar 2
| CPT® Codes for retinal imaging | |
| Current CPT Code Descriptions (CMS Rate) | Code Changes and New Codes (CMS Rate*) |
| 92250: Fundus photography with interpretation and report (CMS $45.83) | 92250: Covers screening/diagnosis or monitoring where the review is performed by a physician in the office where the image was captured (CMS $36.78*) |
| 92227: Screening examination for the asymptomatic patient at risk for a condition such as diabetic retinopathy (CMS $13.71) | 92227: Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral (CMS $15.49*) |
| 92228: Remote imaging requirement for monitoring and management of patients with active retinal disease (CMS $34.65) | 92228: Imaging of retina for detection or monitoring of disease; with remote physician or qualified health professional review and report, unilateral or bilateral (CMS $28.71*) |
| 92229 (new): Imaging of retina for detection or monitoring of disease; with point-of-care automated analysis with diagnostic report; unilateral or bilateral (CMS $11.94*) |
* Proposed rate pending final approval in December 2020, effective January 1, 2021.