Optometry Coding & Billing Alert
Check EO Frequency
Question: What are the rules regarding how often I can report extended ophthalmoscopy on one patient? "Other conditions usually require no more than one or two examinations per eye, per year," says Group Health. Guidelines are likely to vary depending on your location; check your local carrier for a local medical review policy (LMRP) or local coverage determination (LCD).
New York Subscriber
Answer: The frequency of extended ophthalmoscopies depends on the condition of the patient. Group Health, the Medicare Part B carrier for upstate New York, expects to see five or six EOs per eye, per year for patients with conditions "coded with ICD-9 codes 360.0-365.9," which describe glaucoma as well as disorders of the globe, retina, choroid and iris. However, the carrier would not expect to see more than four examinations per eye, per year for patients diagnosed with:
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