BlueCross BlueShield of Tennessee Medical Policy Manual

Retinal Telescreening for Diabetic Retinopathy

DESCRIPTION

Retinopathy screening and risk assessment with digital imaging systems are proposed as an alternative to conventional dilated fundus examination in diabetic individuals. Digital imaging systems utilize a digital fundus camera to acquire a series of standard field color images and/or monochromatic images of the retina of each eye. The digital images that are captured may then be evaluated on site or 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, examples include:

The 2016 diabetic retinopathy screening recommendations of the American Diabetes Association are provided below.

Diabetes Type

Recommended Time of First Exam

Follow-up Exam

Adult - Type 1

Within 5 years of diagnosis

Annually*

Adult -  Type 2

At time of diagnosis

Annually*

Considering pregnancy (not gestational diabetes)

Before pregnancy or early in the first trimester of pregnancy

Every trimester during pregnancy and 1 year postpartum

*Less frequent exams (every 2 years) may be considered following one or more normal annual eye exams

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve the individual’s health status. Telemedicine is sometimes associated with direct 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/ tele-imaging 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.

SOURCES

American Academy of Ophthalmology. (2017, December). Diabetic retinopathy. Retrieved December 20, 2017 from https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp-updated-2017.

American Diabetes Association. (2018). Microvascular complications and foot care: Standards of medical care in diabetes-2018. Retrieved December 20, 2017 from http://care.diabetesjournals.org/content/41/Supplement_1/S105.full-text.pdf.

American Telemedicine Association. (2011, February). Telehealth practice recommendations for diabetic retinopathy, second edition. Retrieved December 20, 2017 from http://hub.americantelemed.org/resources/telemedicine-practice-guidelines.

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2017). Retinal telescreening for diabetic retinopathy (9.03.13). Retrieved December 20, 2017 from BlueWeb. (34 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination. NCD for intraocular photography (80.6). Retrieved March 9, 2016 from https://www.cms.gov.

Mansberger, S.L., Sheppler, C., Barker, G., Gardiner, S.K., Demirel, S., Wooten, K., & Becker, T.M. (2015). Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: a randomized clinical trial. JAMA Opthalmology, 133 (5), 518-525. Abstract retrieved December 20, 2017 from PubMed database. 

Micheletti, J. M., Hendrick, A. M., Khan, F. N., Ziemer, D. C., & Pasquel, F. J. (2016). Current and next generation portable screening devices for diabetic retinopathy. Journal of Diabetes Science and Technology, 10 (2), 295-300. Abstract retrieved March 9, 2016 from PubMed database.

National Institute for Health and Care Excellence. (2015). Type 1 diabetes in adults: diagnosis and management. Retrieved December 20, 2017 from www.nice.org.uk/guidance/ng17.

Shi, L., Wu, H., Dong, J., Jiang, K., Lu, X., & Shie, J. (2015). Telemedicine for detecting diabetic retinopathy: a systematic review and meta-analysis. British Journal of Ophthalmology, 99, 823-831. (Level 1 evidence)

Sreelatha, O. K. & Ramesh, S. V. (2016). Teleophthalmology: improving patient outcomes? Clinical Ophthalmology, 2016, (10), 285-295. (Level 2 evidence)

U.S. Food and Drug Administration.  (May, 1999). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K990205. Retrieved June 5, 2013 from http://www.accessdata.fda.gov. 

Villa, R. S., Alvarez, A. C., Del Valle, de D. R., Mendez, S. R., Garcia, C. M., Garcia, R. M., et al. (2016). Five-year experience of teleophthalmology for diabetic retinopathy screening in a rural population. Archivos de la Sociedad Española de Oftalmología, [Epub ahead of print]. Abstract retrieved March 9, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  1/14/2012

MOST RECENT REVIEW DATE:  1/25/2018

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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.

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