Wiki Diabetic Eye exam (S3000) vs 92015

Create Wiki
B

becca12

Networker
Messages
31
Location
Idaho
Best answers
0
Hello all,

I am wondering if anyone had some documentation on when to code the diabetic eye exam S3000 vs 9201x for a patient that has diabetes and is coming in for a year eye exam. In the documentation that I am reviewing there isn't much difference between a patient that doesn't have a diabetes to a patient with diabetes.

Thanks,
Becca
 
It depends what the payer wants. S codes are not accepted by most payers so unless specifically instructed to by payer use the 92015
 
The documentation would obviously include the presence of diabetes in the ROS and any medications the patient is taking to control the condition. In the internal ocular examination portion of the exam for the retina, a note should be made as to whether the patient doesn't or doesn't have diabetic retinopathy.

I would also recommend that a 99204 CPT code be used for the exam for a new patient and would not use the "S" code you asked about.

Tom Cheezum, O.D., CPC, COPC
 
Diabetic exam

I have a question somewhat related to this, do you have to have an oral/insulin code (Z code) with diabetes (E11.9) for billing insurances? It came up in our meeting this morning and I just have gotten several different answers. One person said if you are not treating the diabetes you don't need to bill the Z code, the other person said yes you should use it for every diabetic patient. HELP!

Thanks- Jennifer Rogers, CPC
 
For Premera Blue Cross, you do not have to have the Z code for oral/insulin use as not all diabetics at risk for eye damage are prescribed medications. If they are using medications it would be appropriate to use the code.

HCPro: Code all documented conditions that coexist. Code all documented conditions that coexist at the time of the encounter, and require or affect patient care treatment or management. Do not code conditions that a physician previously treated and no longer exists. However, coders may use history codes as secondary codes when the historical condition or family history has an effect on current care or influences treatment.
 
I've worked with a few practices who were not getting paid for the E11.9 code. When we investigated what the billers were submitting, we found that they weren't also coding for the oral/insulin Z codes when appropriate. When they added this codes to the claims, they were paid.

I would suggest that you use the appropriate Z code(s) in addition to the E11.9 just to hopefully save you some time having to resubmit if the carrier does want them used. It takes less time to add them to the initial claim versus having to resubmit.

Tom Cheezum, O.D., CPC, COPC
 
You must log in or register to reply here.
Top