1. Coding for Macular Degeneration 1

2. Office visit as above, 92 or 99 Frequency -As medically indicated (q 1mo, 3 mo, 6mo, 12mo) -No limit on office visits - AOA recommends q 4 - 6 months, depending on risk & severity 2

3. Coding for Macular Degeneration Level of Office Visit - Severe AMD may support higher level - AMD complicated with other disease (eg, glaucoma) may support higher level 3

4. Coding for Macular Degeneration Special Tests Scanning Imaging (GDx, OCT) Visual Fields Fundus Photo Extended Ophthalmoscopy Genetic Test Misc Tests 4

5. Coding for Macular Degeneration 92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, retina retina 5

6. Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF No dedicated CPT No dedicated CPT Am. Acad. of Ophth. recommends 92499 Unlisted service Average Medicare 92499 payment = $111 in 2008 Average Medicare 92499 payment = $111 in 2008 6

7. Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF 92499 - Submit documentation, describe nature, extent, medical necessity, time, effort, equipment 7

8. Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF Some use 92250 ( ↑ $$) LCD may not allow scanning laser or be silent file://localhost/Users/alanhomestead/Documents/My Documents B 3-8- 13/Adventures 11-3-12/O - S/Presentations/A-O/Loose Pages/14 Bill Photo w Scan Laser.docx file://localhost/Users/alanhomestead/Documents/My Documents B 3-8- 13/Adventures 11-3-12/O - S/Presentations/A-O/Loose Pages/14 Bill Photo w Scan Laser.docx 8

9. Coding for Macular Degeneration Visual Fields AOA suggests central 10 Deg annually 9

10. Coding for Macular Degeneration Visual Fields Foresee Preferential Hyperacuity Perimeter aka, Foresee PHP™ Visual field analyzer Tests one stimulus brightness level, matches 92081 Vendor recommends every 3-4 months for at risk 10

11. Coding for Macular Degeneration Visual Fields Foresee Preferential Hyperacuity Perimeter LCD may say: -visual field examinations performed at unusually frequent intervals may be reviewed 11

12. Coding for Macular Degeneration Extended Ophthalmoscopy Rare size requirement No color requirement 12

13. Coding for Macular Degeneration Genetic Test Macula Risk (ArcticDX, Toronto, Ontario) 1st genetic test for AMD 866-964-5182 13

14. Coding for Macular Degeneration Genetic Test Obtain test kits from ArticDX (no cost) Take oral swab from patient (office visit) Results forwarded to doc (no fee to doc) Discuss results with patient (office visit) Lab bills insurance directly 14

15. Coding for Macular Degeneration Macular pigment optical density MPOD -no CPT -no CPT -can bill 92499 Unlisted service -can bill 92499 Unlisted service -collect from patient -collect from patient -Vendors: Macuscope by Marco, MPOD by Tinsley -Vendors: Macuscope by Marco, MPOD by Tinsley 15

16. Coding for Macular Degeneration Color Vision 92283 –AOA mentions ? 16

17. Diabetes file://localhost/Users/alanhomestead/Do cuments/My Documents B 3-8- 13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/Diabetes/Diab Aug 13.ppt file://localhost/Users/alanhomestead/Do cuments/My Documents B 3-8- 13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/Diabetes/Diab Aug 13.ppt 17