If a patient who has a long standing complication (for example DM w/CKD E11.22) has a diabetic eye exam (92228), can their complication be coded as unspecified (E11.9) simply to get the scan paid? In every other coding situation, if a patient has a complication, you can no longer go back and code it as non complicated.
It seems non compliant to dismiss a patient's complication and code them as having diabetes with no complications just for payment.
We're being told that it should be downcoded to an unspecified complication because the test has nothing to do with the CKD or neuropathy or leg ulcer or whatever other diabetic complication. The payable dx list is very specific to only eye issues which I understand, however, if the patient has DM w/ CKD or DM w/ neuropathy, they're already experiencing problems due to their diabetes. Wouldn't it make sense that if they have 1 complication, then they could eventually have others that potentially affect the eyes? An eye test seems appropriate for all diabetic patients regardless of what complication they're diagnosed with , it's unfortunate that the dx list isn't more inclusive.
It's always been 'be specific, be specific, be specific' , but now only for this 1 test (because it's not paying) we're back tracking and taking off the specificity.
And is 92227 strictly for diabetic patients without retinopathy and then when retinopathy is detected it moves to 92228?
It seems non compliant to dismiss a patient's complication and code them as having diabetes with no complications just for payment.
We're being told that it should be downcoded to an unspecified complication because the test has nothing to do with the CKD or neuropathy or leg ulcer or whatever other diabetic complication. The payable dx list is very specific to only eye issues which I understand, however, if the patient has DM w/ CKD or DM w/ neuropathy, they're already experiencing problems due to their diabetes. Wouldn't it make sense that if they have 1 complication, then they could eventually have others that potentially affect the eyes? An eye test seems appropriate for all diabetic patients regardless of what complication they're diagnosed with , it's unfortunate that the dx list isn't more inclusive.
It's always been 'be specific, be specific, be specific' , but now only for this 1 test (because it's not paying) we're back tracking and taking off the specificity.
And is 92227 strictly for diabetic patients without retinopathy and then when retinopathy is detected it moves to 92228?