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Diabetic Eye exam (S3000) vs 92015

  1. #1
    Default Diabetic Eye exam (S3000) vs 92015
    Medical Coding Books
    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

  2. #2
    Default
    It depends what the payer wants. S codes are not accepted by most payers so unless specifically instructed to by payer use the 92015
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. Default
    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

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