[ Diabetes Type 2 ]

Ophthalmological Exams – Diabetes

If the visit was scheduled at the request of the physician, you can report 99211. health care system suffers a quality deficit in part because too many patients do not get the effective preventive care they need when they need it.”1 The organization cites the potential to save more than 100,000 lives annually by simply increasing the use of just five preventive services, including providing smoker counseling and assistance to quit and breast screening for women. You will have to study this carefully and change the way you have been coding your vitreoretinal surgeries. Clinical evaluation, performed by the certifying physician within six (6) months prior to delivery, that addresses the beneficiary’s diabetes management. In many cases an ophthalmologist or optometrist examines the patient’s eyes only, but does not treat or manage the patient’s other medical conditions. Modifier 25 should be appended to the preventive medicine service code to indicate that the work involved in providing the preventive medicine service was significant and separately identifiable from that of the developmental testing. The preventive medicine comprehensive examination documentation requirements represent significant work for the physician or other provider, and payer fee schedules appropriately reflect that work.

It is very different from the old system, which was essentially one of pigeonholes. The information must be received within 45 days of the date of the letter or the claim will be denied. Office visit codes may also be used to represent higher-level services in cases that are extremely complex and require a high level of medical decision making. If the patient is a Medicare beneficiary, make sure that you are meeting the requirements outlined in Chapter 15, Section 220.2 of the Medicare Benefit Policy Manual. Physician practice office staff can encounter administrative challenges for accurate claims submission for preventive medicine services. Thus, it behooves the physician to be sure to code all surgeries and be cognizant of the new codes. However, routine ophthalmoscopy is included in the ophthalmological service codes and should not be reported separately.

Most HPH plans include benefits for routine vision services. If you code based on key components, you do not have to meet the average times noted in CPT. Also, with the exception of the one-time Medicare initial preventive physical exam, Medicare does not cover annual or “routine” physicals.3 Therefore, Medicare does not provide reimbursement for the CPT comprehensive preventive medicine services codes. Another decision that needs to be made is whether or not to bring office-based procedures, such as intravitreal injections, into the ASC. Like Medicare, Akamai Advantage does not include benefits for routine vision services. However, Akamai Advantage members are eligible for vision exams when the services are appropriate for diagnosing and treating a medical condition. The global period assigned to code 10061, “Incision and drainage of an abscess; complicated,” is 10 days.

Tags: , ,