Past the age of 40, at least 20% of people have some form of Diabetes in your practices.
Helping patients get control of it has become a primary role of optometrists as a result of regulations put in place as a result of "Obama Care". Even if this had never happened, or if it is repealed and replaced by the oncoming administration, diabetes will continue to be a growing and important part of optometric practices nationwide. With that in mind, here are some important ways that you can manage a diabetic patient who presents with, for example, Capillary Exudates and the proper way to handle your optometric billing to these patients' insurance.
- Remind Patient to work with their primary Physician or Endocrinologist
- As you know, Diabetes creates vascular changes in the Eye including hemorrhaging and Capillary Exudates (H35.89). Let's suppose your patient presents with an H35.89, this supports the billing of the following procedure codes: 92133(POSTERIOR OCT OPTIC NERVE),92134(POSTERIOR OCT RETINA),92227(REMOTE IMAGING), 92228(REMOTE IMAGING/MANAGEMENT OF ACTIVE RETINAL DISEASE), 92081,92082,92083,92225,92226,92275 and Exam (92004,92014, Etc)
Its important to note that though all of these procedures are available to you, they 1) may not be covered in your locality to due to "local coverage determinations" (LCD) and they 2) should not all be done on the same day. A subscription to EYECOR is your best method for deciding the proper coding for your optometric billing for these patients and which services can and should be performed in your location.
It is also important to consider that diabetes patients are not only valuable to your practice but that the vast range of services their condition opens up to you in terms of billing and reimbursement is also a valuable tool for the management of their condition. For example, 92133, 92134 and 92250 may NOT be performed on the same day with just one Diagnosis code...NOR SHOULD THEY! However, by splitting up these services and bringing the patient back multiple times so that you can properly administer all the testing available to you, you are not only increasing the bottom line of your practice but you are also making the patient feel more cared for, BETTER cared and ultimately that you care about them and their health.
If you were wondering what these services might be worth to you for a Medicare patient, for example, here is the reimbursement breakdown for a NEW patient being seen by a doctor in Los Angeles, CA:
Day 1:92004-167.31
92083-73.90
92225-30.09
92250-76.02
Total: $347.32
Day 2: 92133-42.46
Day 3: 92134-46.43
Day 4: 92227-$17.07
Day 5: 92014- (final discussion of findings and treatment plan implementation) $139.41
Total Medicare reimbursement for New Diabetes patient: $499.83 (each testing procedure may be repeated in this area at least once per year in order to monitor progression of disease ).
Here is a good video to watch from a channel we subscribe too
https://youtu.be/xKeTLrl59a4
