Clinical Context
A 64-year-old patient with a history of age-related macular degeneration presents with new onset central visual distortion and decreased acuity in the right eye. The retinal specialist schedules an indocyanine green angiography study to image the choroidal vasculature and assess for choroidal neovascularization or occult lesions prior to planning treatment. On arrival to the ophthalmology clinic procedure suite, informed consent is confirmed, allergy status reviewed (noting iodine/shellfish allergy is not a contraindication for ICG but latex and prior reactions are queried), intravenous access is established, and baseline vital signs are documented. The technologist prepares the ICG dye and camera system. The provider injects the ICG intravenously, obtains serial fundus photographs using the angiography camera, interprets the dynamic and late-phase findings, documents the interpretation, and generates a formal report in the electronic medical record. Typical sites of service are an outpatient ophthalmology clinic or ambulatory surgical/diagnostic center. This procedure is commonly used when fluorescein angiography is insufficient for imaging deeper choroidal circulation, for evaluation of choroidal tumors, or for pre-procedural planning for laser or photodynamic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | Use when billing only the physician interpretation/report separate from technical imaging if the facility bills the technical component. |
| 52 | Reduced services | Use when the study is partially completed or limited relative to full protocol.
| 53 | Discontinued procedure | Use if the procedure is started but halted for patient safety or other valid reasons.
| 76 | Repeat procedure by same physician | Use when the same provider repeats the angiography during the same encounter for clinical reasons.
| 77 | Repeat procedure by another physician | Use when a second provider repeats the procedure on the same day.
| 78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use if an unplanned repeat intra-procedural intervention occurs requiring return to procedure area.
| 79 | Unrelated procedure or service by the same physician during the postoperative period | Use if an unrelated procedure is performed during the post-op period (included if clinically applicable).
| TC | Technical component | Use when billing only the equipment/imaging component and facility provides the technical service.
| 22 | Increased procedural services | Use when work required is substantially greater than typical, and documentation supports reporting of increased complexity.
| 24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use when an unrelated E/M is provided on the same day as the angiography and the postoperative period applies.
| Taxonomy Code | Specialty | Notes |
|---|
207S00000X | Ophthalmology | Retinal specialists and general ophthalmologists perform and interpret ICG angiography. |
| 207RH0000X | Ophthalmology - Retina/Vitreous | Subspecialists who commonly order and interpret choroidal angiography for retinal disease.
| 2086S0102X | Optometry | Optometrists with advanced procedural privileges in some states may assist in imaging but typically do not interpret/inject ICG.
| 363L00000X | Diagnostic Radiology | Rarely involved for complex ocular imaging protocols in multidisciplinary centers, limited role.
| 103K00000X | Emergency Medicine | May document emergent assessments when angiography is performed in acute care settings, limited applicability.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
H35.32 | Exudative age-related macular degeneration | ICG angiography can detect choroidal neovascular membranes and guide therapy planning. |
| H35.70 | Chorioretinal degeneration, unspecified | Used when choroidal pathologies require deeper vascular imaging for characterization.
| C69.9 | Malignant neoplasm of eye, unspecified | ICG angiography helps evaluate vascular patterns of intraocular tumors.
| H35.8 | Other specified retinal disorders | Includes various retinal/choroidal disorders where choroidal circulation assessment is indicated.
| H35.01 | Nonexudative age-related macular degeneration | ICG may be used in select cases to assess choroidal changes not well-characterized by fluorescein alone.
| H44.5 | Other disorders of globe | When deeper ocular vascular imaging is needed to evaluate complex globe disorders.
| H35.60 | Background retinopathy, unspecified | In some vascular retinopathies, ICG provides complementary information to fluorescein angiography for deeper lesions.
| H31.89 | Other chorioretinal disorders in diseases classified elsewhere | Encompasses choroidal inflammatory or degenerative conditions where ICG is clinically useful.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
92235 | Fluorescein angiography with interpretation and report | Alternative angiography study imaging retinal circulation; often performed when fluorescein better visualizes retinal vasculature or in conjunction when both superficial and deep circulation assessment is needed. |
| 92240 | Indocyanine-green angiography with interpretation and report | This is the primary code describing ICG angiography of the choroidal circulation and associated interpretation.
| 92250 | Fundus photography with interpretation and report | Often performed before or after angiography to document baseline color fundus appearance and correlate structural findings with angiographic patterns.
| 67121 | Repair of retinal detachment; with vitrectomy, with or without scleral buckle; complex cases | Performed in advanced surgical management of diseases identified or characterized by angiography; relates as potential downstream surgical treatment in retinal disease.
| 67036 | Vitrectomy, pars plana; for removal of vitreous opacities, diabetic membranes, or for other vitreoretinal procedures | May be performed following diagnostic angiography when intervention is indicated for underlying retinal/choroidal pathology.
| A9270 | Non-covered item or service; used for reporting investigational dyes or supplies when required by specific payer policies | Occasionally used in billing supply items related to angiographic dyes per payer guidance.