Cost analysis of teleophthalmology screening for diabetic retinopathy using teleophthalmology billing codes

Michael P. Ellis, Colin Bacorn, Kieu Yen Luu, Sophie C. Lee, Steven Tran, Christopher Lillis, Michele C. Lim, Glenn Yiu

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVE: To evaluate the financial sustainability of teleophthalmology screening for diabetic retinopathy (DR) using telehealth billing codes. PATIENTS AND METHODS: The authors performed an Institutional Review Board-approved retrospective review of medical records, billing data, and quality metrics at the University of California Davis Health System from patients screened for DR through an internal medicine-based telemedicine program using CPT codes 92227 or 92228. RESULTS: A total of 290 patients received teleophthalmology screening over a 12-month period, resulting in an increase in the DR screening rate from 49% to 63% (P <.0001). The average payment per patient was $19.86, with an estimated cost of $41.02 per patient. The projected per-patient incentive bonus was $43.06 with a downstream referral revenue of $39.38 per patient. One hundred seventy-eight clinic visits were eliminated, providing an estimated cost savings of $42.53 per patient. CONCLUSION: Sustainable teleophthalmology screening may be achieved by billing telehealth codes but only with health care incentive bonuses, patient referrals, and by accounting for the projected cost-savings of eliminating office visits.

Original languageEnglish (US)
Pages (from-to)S26-S34
JournalOphthalmic Surgery Lasers and Imaging Retina
Volume51
Issue number5
DOIs
StatePublished - May 2020

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

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