Wiki Diabetic Eye Exam in PCP setting (Internal Medicine)

[jhendrix08]

I work in a Primary Care office and my physician is thinking about purchasing the machine/software to perform diabetic eye exams. What would be the correct CPT code since it's being done in the primary care office setting? We're needing to check on reimbursement so I want to be sure I have the correct codes.

I would really appreciate any feedback if any of you have experience with this! Thanks in advance!!

 

[Cynthia Hughes]

Retinopathy screening

It is highly advisable to review the reimbursement policies for the specific test prior to investing. Here are examples of favorable policies for retinopathy telescreening: http://www.aetna.com/cpb/medical/data/500_599/0563.html and https://medicalpolicies.amerigroup.com/medicalpolicies/guidelines/gl_pw_a053783.htm. It is important to verify reimbursement policies of your local payers and also estimate the likely number of screenings (e.g., number of patients with diabetes ICD-10 codes reported) and reimbursement amounts vs. total costs of providing the services (equipment, staff, follow-up communication to patient).

Hope that helps,
Cindy

 

[jhendrix08]

Thank you, Cindy!

Can you share with me how you go about finding these reimbursement policies online? I do have log-ins for most of our payers website but was assuming I would have to call to get the information for something this specific....I should have known that most everything can be found without making a phone call these days!

Thanks again for your time in offering advice.