Fundus Camera

Description of Procedure
The retinal fundus is the interior lining of the eyeball and is the area that can be seen through the pupil during an eye examination. Fundus photography involves the use of the retinal camera to photograph regions of the vitreous, retina, choroid and optic nerve. The resultant images may be either photographic or digital and become part of the patient’s permanent record.

Fundus photography is used to document abnormalities of the eye or disease progression for conditions such as macular degeneration, glaucoma, neoplasms of the retina and choroid (benign and malignant), retinal hemorrhages, ischemia, retinal detachment, choroid disturbances, and diabetic retinopathy. It may also be used for assessment of recently performed retinal laser surgery.

The benefits of Fundus photography 
Fundus photography may be considered medically necessary when used to document a clinically relevant condition that is subject to change in extent, appearance or size, and where such change would directly affect the management of the condition.

Policy Guidelines
In general, Fundus photography may be considered medically necessary if performed to:
- evaluate abnormalities in the fundus
- follow the progress of a disease
- plan the treatment for a disease
 - assess the therapeutic effect of recent surgery (for example: photocoagulation)
 
Fundus photography is not medically necessary simply to document the existence of a condition. Photographs are medically necessary to establish a baseline to judge later if a disease is progressive. Examples are as follows: It does not add to the patient’s care to  photograph dry age related maculopathy simply to document its existence. However, Fundus photography can establish the extent of retinal edema in moderate non-proliferative diabetic retinopathy. In four to six months, the baseline photograph can be compared to the clinical appearance of the current diabetic retinal edema to see if it is progressing to clinically significant diabetic macular edema. This information can be used to decide clinical management. The intent of this scenario is to point out how in the former example there is not a therapeutic decision being made; in the later there is. Fundus photography should aid in making a clinical decision.