How should I bill an exam when a patient requests a routine exam (has no chief complaint), but an eye problem is discovered?
Regardless of final diagnosis, a patient who presents for an eye examination with no complaint must be reported as a routine eye examination (initial visit only) listing ICD-9 codes V72.0 or 367.0 through 367.9 as the primary diagnosis in box 21 and the diagnosis reference point in Box 24E of Form CMS-1500. Any medical diagnosis should be listed as secondary. The coverage of services rendered by an eye care provider is dependent on the purpose of the examination rather than on the ultimate diagnosis of the patient’s condition. Therefore, if a patient presents to a provider’s office for a routine examination, and during the course of the examination a medical diagnosis is discovered, the examination is still reported as routine. This information is based on a Medicare determination, which can be found in the Medicare Carrier Manual, Part 3, under Coverage and Limitations 08-94 section 2323. CMS makes it very clear that coverage for ophthalmology exams is determined based on the “purpose
Related Questions
- How should I bill an exam when a patient requests a routine exam (has no chief complaint), but an eye problem is discovered?
- Why does the Board have to become involved in every patient complaint, no matter how minor or frivolous the problem ?
- Why are contact lens exams not covered as part of my insurances routine eye exam benefit?
