So, the first part of your question- diabetes diagnosis. To use a 249 code for borderline diabetes is wrong because the 249 code is for secondary diabetes, which might be like a drug induced situation, not borderline. The appropriate code for borderline diabetes is 790.29. Once they were classified as a diabetic, then it would be appropriate to use a 250 code.
As far as the diagnosis codes for the exam and glasses, yes, it is normal to use a medical diagnosis for an exam but then a refractive diagnosis for the eyeglasses. The reason for this is because the diagnosis for the exam is what qualifies the medical necessity of the visit- it is medically necessary for a diabetic to have their eyes examined to make sure their diabetes is not affecting thier eye health. Then for the glasses, you have to ask why are the glasses needed- if a diagnosis for diabetes was used for the eyeglasses, that would not be appropriate because that's not why they need glasses. They need glasses because of presbyopia. So the second scenerio is correct- it is normal to see different diagnosis for an exam and glasses, but sometimes you will see a refractive diagnosis for both which is also appropriate.
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