DESCRIPTION
Digital imaging systems utilize a digital fundus camera to acquire a series of standard field color images of the retina of each eye. This type of retinopathy screening and risk assessment is proposed as an alternative to conventional dilated fundus examination, particularly in those diabetic individuals who are not compliant with the recommended periodic retinopathy screenings. The digital images that are captured may then be evaluated on site and stored for comparison with subsequent retinal images of the same individual or they may be transmitted via the Internet to a remote center for interpretation by trained readers, storage and subsequent comparison. This technology has made possible the linking of diabetic individuals in remote locations (where screening might otherwise not be available) with specialty centers that determine if retinopathy is present and recommend treatment if needed.
There are currently several digital camera and transmission systems available:
The Diabetic Retinopathy Digital Disease Detection and Tracking System (Inoveon Corp., Oklahoma City, OK)
DigiScope ® (EyeTel Corp., Columbia, MD) in conjunction with the Wilmer Eye Institute at Johns Hopkins Medicine
The Fundus AutoImager™ (Visual Pathways Inc., Prescott, AZ)
ImageNet™ Digital Imaging System (Topcon Medical Systems Inc., Paramus, NJ)
Zeiss FF450 Fundus Camera and the VISUPAC® Digital Imaging System (Carl Zeiss Meditech Inc., Dublin, CA)
The American Academy of Ophthalmology (AAO) has recommended the following eye examination schedule:
|
Diabetes Type |
Recommended Time of First Examination |
Recommended Follow-up* |
|
Type 1 |
5 years after onset |
Yearly |
|
Type 2 |
At time of diagnosis |
Yearly |
|
Prior to pregnancy (In preexisting diabetes; type 1 or type 2) |
Prior to conception or early in the first trimester |
No retinopathy to mild
or moderate nonproliferative diabetic retinopathy: every 3-12 months |
*Abnormal findings may dictate more frequent follow-up examinations.
POLICY
Retinal telescreening with a digital imaging system and manual grading of images as a screening technique for diabetic retinopathy is considered medically necessary.
Retinal telescreening for all other indications, including, but not limited to, the monitoring and management of disease in individuals diagnosed with diabetic retinopathy is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member’s health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Telemedicine is sometimes associated with direct patient clinical services and telehealth with a broader definition of remote healthcare services. Digital imaging systems may be used in the primary care physicians' office. Services that involve the electronic transmission of digital images across the Tennessee State line must adhere to all applicable Tennessee State requirements for the practice of medicine
Both the American College of Radiology and the American Medical Association recommend that physicians using Teleradiology/ teleimaging should be licensed in both the state where the images were generated and the state where the images are interpreted. Equipment specifications should assure the same image quality and availability if used for the initial diagnostic image interpretation, or for a review. Transmission and storage of images should adhere to appropriate privacy guidelines and restrictions.
There is no evidence to support the use of retinal telescreening to monitor or manage diabetic retinopathy as it does not alter the treatment choices or improve medical outcomes.
SOURCES
American Academy of Ophthalmology. (2008, September). Preferred Practice Pattern. Diabetic retinopathy. Retrieved July 29, 2009 from http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=d0c853d3-219f-487b-a524-326ab3cecd9a#relatedLinks.
American Diabetes Association. (2010). Standards of medical care in diabetes-2010. Retrieved August 19, 2011 from http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.pdf+html.
American Telemedicine Association. (2011, February). Telehealth practice recommendations for diabetic retinopathy. Retrieved August 18, 2011 from http://www.americantelemed.org/files/public/standards/DiabeticRetinopathy_withCOVER.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2011). Retinal telescreening for diabetic retinopathy (9.03.13). Retrieved August 18, 2011 from BlueWeb. (20 articles and/or guidelines reviewed)
Cavallerano, J., Bursell, S. E., & Aiello, L. M. (2007, October). Validated telemedicine for diabetic retinopathy. Retrieved August 19, 2011 from http://www.retinalphysician.com/article.aspx?article=101007.
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, April). Intraocular photography (NCD 80.6, p. 2-44 - 2-45). Ingenix.
Farley, T., Mandava, N., Prall, R., & Carsky, C. (2008). Accuracy of primary care clinicians screening for diabetic retinopathy using single-image retinal photography. Annals of Family Medicine, 6 (5), 428 - 34. (Level 5 - Independent study)
National Guideline Clearinghouse. (2008, September). American Academy of Ophthalmology Retina/Vitreous Panel, Preferred Practice Patterns Committee. Diabetic retinopathy. Retrieved July 29, 2009 from http://www.guidelines.gov.
Taylor, C. R., Merin, L. M., Salunga, A. M., Hepworth, J. T., Crutcher, T. D., O’Day, D. M., et al. (2007) Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: The Vine 2227Hill study. Diabetes Care, 30 (3), 574-578. (Level 4 - Independent study)
Vujosevic, S., Benetti, E., Massignan, F., Pilotto, E., Varano. M., Cavarzeran, F., et al. (2009). Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs. 7 standard early treatment diabetic retinopathy study fields. American Journal of Ophthalmology, 148 (1), 111-118. (Level 3 - Independent study)
ORIGINAL EFFECTIVE DATE: 1/14/2012
MOST RECENT REVIEW DATE: 1/14/2012
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.