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

Abstract

BACKGROUND AND OBJECTIVE: To oval uate 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 telehualth codes but only with health care incentive bonuses, patient referrals, and by accounting for the projected cost-savings of eliminating office visits.