Optometry Coding & Billing Alert
If It's Not Relevant to Encounter, Leave Chronic Condition Dx off Claim
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Question: A patient with type II diabetes reported to the optometrist for an exam. The patient was also complaining of a headache and neck pain. Should we include a diagnosis code for diabetes on this claim, or should we just code for the symptoms that the patient lists for this visit? Answer: It depends on the situation. Diabetes is a chronic condition, and you should only report ICD-9 codes for chronic conditions when they are relevant to the service the physician provides. But if the diabetes does not affect the optometrist's treatment options or is otherwise not addressed during the encounter, you should report only 784.0 and 723.1 as diagnoses.
Missouri Subscriber
If the optometrist considers the diabetes during the patient's course of treatment, you should attach the following ICD-9 codes to your procedure code(s):
- 784.0 (Headache) to represent the patient's headache.
- 723.1 (Cervicalgia) to represent the patient's neck pain.
- 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) to represent the diabetes.
Optometry Coding & Billing Alert
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