![]() Look at what you are telling the carrier: here is a patient “without complications” on whom you have performed a fundus photograph. ![]() Here is a clinical example of a question that get asked by colleagues far more frequently than I would like to admit-“Can I do a fundus photograph (CPT 92250) on a patient with a diagnosis of E11.9 (Type 2 Diabetes without Complications)?” I see people trying to submit this combination far too frequently. In fact, the ICD-10 is creating areas of audit exposure due to the specificity of the codes.Ī. Keep in mind that medical necessity rules the day-you must ensure that any test that you are ordering or performing must play a role in clinically managing the patient and can’t be performed just to document a condition. A statement of medical necessity for any return office visits to your practice or for any ordered special ophthalmic procedures should be clearly stated in your assessment and plan for the office visit performed that day. 2 Keep in mind that good medical record protocol dictates that the dilating agent(s) should be listed.ģ. ![]() According to the 1997 CMS E&M Guidelines that govern any 992XX code, when the retinal components of a single system eye examination are performed, they must be performed through a dilated pupil unless contraindicated because of age or medical reasons. According to the CPT, when performing any 920XX code, dilation is not mandatory, but defined as, “often includes, as indicated.” 1Ģ. Therefore, there are a few things to keep in mind when coding for retinal examinations and/or special ophthalmic procedures related to the retina.ġ. With the implementation of the ICD-10, greater scrutiny is being placed upon claims data relating to specific diagnoses and medical necessity. These days, however, OD’s can be intimately involved in diagnosing retinal disease and in the active management of many retinal conditions. The retina has long been a popular topic of discussion within our professional clinical journals, but the average OD hasn’t been actively managing retinal conditions. If you look at the collective array of special ophthalmic procedures that the average optometrist performs, the majority of tests are for the retina. Ask any insurance auditor what creates the largest area of concern for any ophthalmic physician-special testing related to the retina/posterior pole.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |