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Ophthalmology and Optometry Coding Alert

You Be the Coder:

FP for Diabetic Patient

Published on Wed Apr 26, 2006

Question: We submitted a claim for 99204 and 92250 to Medicare. The diagnosis code for both was 250.50. Medicare continues to deny this claim, but I don't know why. The denial says, "missing/incomplete/invalid diagnosis or condition."


Ohio Subscriber


Answer: You may need an additional ICD-9 code to identify the specific ophthalmic problem the patient presents with.

ICD-9 code 250.50 (Diabetes with ophthalmic manifestations; type II or unspecified type, not stated as uncontrolled) is the correct code for type II diabetes with ophthalmic manifestations, but ICD-9 rules require you to use another code to say what, exactly, the ophthalmic manifestations are.

Link 99204 (Office or other outpatient visit for the evaluation and management of a new patient ...) and 92250 (Fundus photography with interpretation and report) to the ophthalmic manifestation--such as macular edema (362.07), glaucoma (365.44) or retinopathy (362.01-362.07)--as a secondary diagnosis.

Be sure to check with your carrier, though. It may want just the manifestation code and not the diabetes code at all.

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