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Diabetic Eye Exam

Sherri Posted Tue 12th of February, 2019 14:45:09 PM
I always seem to have trouble when patients come in for a yearly diabetic eye exam. It is a Medicare covered benefit, and should not be subject to deductible or copay. I filed the claim with 99204 and E11.9 as the diagnosis. The claim paid but the patient ended up owing a copay. I get the run around on the Medicare site, and Humana is even worse for tying to get a specific answer. They do not give specific guidelines, Am I using the wrong codes? Can you give me any tips?
SuperCoder Answered Wed 13th of February, 2019 03:16:17 AM

Hi Carol,

It is appropriate to bill CPT 92014 for a yearly diabetic eye exam, if comprehensive with E11.9 as diagnosis code. Also see the below link to give you more clarity on eye exam related codes.

Feel free to ask for any further query. Thank you

https://www.aoa.org/Documents/optometric-staff/Articles/Basics-Billing-and-Coding-Eye-Exam.pdf

 

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