Coding and Reimbursement
Billing for ICG Angiography
An expert answers frequently asked questions.

BY SUZANNE L. CORCORAN, COE

As you know, indocyanine-green (ICG) angiography is an ophthalmic photographic test used to visualize abnormalities of the choroid. The procedure requires the intravenous injection of ICG dye, followed by rapid-succession photography through a dilated pupil, with images captured on digital video imaging systems. Here's what you need to know to optimize reimbursement and avoid payer problems.

Q: Which CPT code applies to this test? The CPT code for ICG angiography is 92240 (indocyanine-green angiography [includes multiframe imaging] with interpretation and report). ICG angiography is a unilateral test, so when both eyes are tested, payment is made in full for each eye. (Note: You must document medical necessity for each eye.)

Q: What are the reimbursement amounts for this test? The Medicare national allowable amount for 92240 in 2002 is $232 per eye, which is adjusted by local wage indices in each area. Commercial insurers set their own fee schedules, with payment rates generally between $265 and $385. Of course, contracted rates can be very different.

Medicare -- and most other payers -- won't pay separately for either the IV infusion of the ICG dye or the supply of the dye itself.

Q: Can we bill for both ICG angiography and an office visit or other tests? It depends:

The exam. Medicare doesn't bundle ICG angiography with exams; you can bill Medicare for both. Some private payers, however, may refuse to pay separately for an exam and diagnostic tests performed on the same day.

Fundus photography. Fundus photography is commonly performed with ICG angiography to document anatomical landmarks as an aid to laser therapy, but Medicare bundles fundus photography and won't pay separately.

Fluorescein angiography. No overt rule precludes reimbursement for concurrent fluorescein angiography, but we've heard anecdotal reports of delays in payment and intermittent denials when ICG and fluorescein angiography are performed on the same day.

Q: What documentation is required to support claims for ICG angiography? Documentation in the medical record must include:

• patient's name and date of service
• indications for testing
• an order for ICG angiography
• the patient's informed consent for the procedure
• test results (i.e., photographs)
• interpretation of the test
• the doctor's signature.

As with other diagnostic tests that have a physical output (such as visual fields or fundus photos), many physicians review the photographs and make a mental interpretation, but neglect to write their findings in the chart. If this happens, only a portion of the test -- the technical component -- is billable. In fact, a reviewer might presume that the absence of a written interpretation indicates that there was no real reason to perform the test, and deny the entire charge! It's crucial to have written interpretations of all diagnostic tests.

You should also document the patient's condition throughout the test, to protect you in case the rare patient has a reaction to the injected dye. If this occurs, the chart should document any care you provided to counteract the reaction and any discharge instructions you provided to that patient.

Q: What justifies reimbursement for this test? A variety of diseases justify testing, but most Medicare reimbursement policies for ICG angiography focus on the diagnosis and treatment of choroidal neovascularization. Medical necessity should be supported by signs, symptoms, and/or medical history.

Non-Medicare payers generally agree.

Suzanne L. Corcoran, COE, is vice president of Corcoran Consulting Group. She can be reached at (800)399-6565 or via email at scorcoran@corcoranccg.com.