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  • 1.  Interpretation fundus photos

    Posted 15 days ago

    Hello! 
    Wondering if anyone can comment about your experience billing and interpreting fundus photos ordered by other providers (general neurologist, APP's). 
    - interested in knowing Insurance denial rates
    - inconclusive answers turning into consults 

    thanks for your time. 
    Wishing everyone a wonderful lunar new year in advance. 
    Helena



    ------------------------------
    Wen Y. Helena Wu-Chen, MD, FAAN
    LGHP Neurology Clerkship Site Director
    LGHP Neurology | Neuro-ophthalmology
    Adjunct Assistant Professor of Neurology, Lewis Katz School of Medicine, Temple University
    Neuroscience Institute
    2150 Harrisburg Pike, Suite 200A
    Office: 717-396-9167 Fax: 717-396-9064
    ------------------------------


  • 2.  RE: Interpretation fundus photos

    Posted 14 days ago
    You cannot bill for interpretation of a photo if the individual who obtained the photo billed globally or already performed an interpretation with the professional component modifier.
    However, if someone else  only billed the technical component, you could bill the professional component for the interpretation.

    Matt


    Sent via the Samsung Galaxy S21 5G, an AT&T 5G smartphone






  • 3.  RE: Interpretation fundus photos

    Posted 14 days ago
    These numbers obviously depend on where you practice and is proportional to the number of successful billing/collection rate at your institution (which is usually not that high). 

    Like for any imaging study, it is classic to split the billing fee between the technical fee (goes to specialty hosting the camera and taking the pictures) and the medical fee (goes to the interpreting ophthalmologist) - this is similar to what happens in radiology for example, and we had requested this option from those designing the EHR templates (we use EPIC). 

    At Emory, we have cameras in the ED where pictures are obtained by ED staff and ophthalmologists provide an official interpretation of all images with billing happening automatically through the EHR similar to what is done when ocular imaging is obtained in the eye clinic. We had this designed in our EHR when we implemented the camera. The technical fee goes to the ED and the medical fee goes to Ophthalmology and is credited to the ophthalmologist interpreting the pictures. 

    We have reviewed the number of successful billing (happens almost all the time) and effective collection of $ (happens less often, but is actually similar to the % of successful collection documented for our department, and therefore seems to grossly work). 

    It is definitely possible and working and the billing ophthalmologist makes sure the reason for the ocular imaging is supporting imaging at the time of interpretation (papilledema, diabetes, hypertension, etc...). 

    We are currently looking at details to identify barriers and increase revenue, but will only have results we can share at the end of 2026. Billing in the ED is quite complex and will vary in other institutions, but yes, you can bill for imaging obtained in the ED and neurology clinics. 

    For data on consultations and imaging, please look at the two papers referenced below. How often pictures eliminate an ophthalmology consultation obviously also depends on the institution's needs and practice and pathology seen. Cameras do not replace ophthalmology consultations when there is ocular pathology identified. They accelerate and facilitate the process in the ED. However, they replace consultations for normal eye examinations in the vast majority of cases, especially rule-out papilledema consultations which are avoided in 96% of cases at our institution. Cameras also avoid unnecessary transfers. 


     McHenry JG, Lin MY, Pendley AM, Yan KY, Alencastro Landim G, Shanmugam N, Duffield S, Adamkiewicz DV, Vo DT, Prosky J, Keadey MT, Wright DW, Fischer AF, Dattilo M, Newman NJ, Biousse V. Nonmydriatic Ocular Fundus Imaging on Consecutive Patients Seeking Treatment at a General Emergency Department with Vision Symptoms. Ophthalmology. 2026 Feb;133(2):178-186. doi: 10.1016/j.ophtha.2025.09.029. Epub 2025 Oct 10. PMID: 41076033.

    Shanmugam N, Lin MY, McHenry JG, Yan KY, Duffield S, Pendley AM, Alencastro Landim G, Adamkiewicz DV, Vo DT, Prosky J, Keadey M, Wright DW, Dattilo M, Newman NJ, Biousse V. Nonmydriatic Ocular Fundus Imaging in a General Emergency Department: Feasibility and Novel Considerations for Systematic Screening. Am J Ophthalmol. 2026 Jan;281:126-137. doi: 10.1016/j.ajo.2025.09.016. Epub 2025 Sep 15. PMID: 40962132.

    I hope this helps you.
    Valerie Biousse





  • 4.  RE: Interpretation fundus photos

    Posted 14 days ago

    If you bill by time, you can incorporate the time spent if you do it on the same day as the patient encounter.

    Deb