Download Eye Specialty Group

Eye Specialty Group
Presents:
Optometry Reimbursement Updates
Presented By:
Kirk Mack, COMT, CPC, COE, CPMA
Senior Consultant
February 21, 2015
Memphis, Tennessee
SEMINAR: Optometry Reimbursement Updates
by
Corcoran Consulting Group
Ardare Corporation
560 E. Hospitality Lane, Suite 360
San Bernardino, California 92408
(800) 399-6565
www.corcoranccg.com
 Copyright 2015
All rights reserved.
Except as permitted under the United States Copyright Act of 1976, no part of this publication may be
reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without
the prior written permission of the author. From time to time, changes may occur in the content of this
material and it is the user's responsibility to assure that current issues of this material are utilized. This
additional information is also copyrighted as expressed above.
Other copyright: CPT and all CPT codes are copyrighted by the American Medical Association with all the
rights and privileges pertaining.
Objective: This material is provided as part of course of instruction on current reimbursement regulations
and practice management techniques. The user is strongly encouraged to review official instructions
promulgated by the Centers for Medicare and Medicaid Services (CMS), and their Medicare administrative
contractors; this document is not an official source nor is it a complete guide on all matters pertaining to
reimbursement.
Disclaimer: The reader is reminded that this information can and does change over time, and may be
incorrect at any time following publication.
WHAT’S NEW?
Executive Summary
•
•
•
•
•
•
Hot Reimbursement Topics
and What’s New
Corcoran Consulting Group
Payment issues
New codes
Regulatory matters
Administrative changes
Incentive programs
Utilization changes
Sustainable Growth Rate (SGR)
2015 MPFS
• Protecting Access to Medicare Act (PAMA) 2014 signed in
early 2014
• SGR Repeal and Medicare Provider Payment
Modernization Act (H.R. 4015/S.2000) – bipartisan,
bicameral legislation
• 0% PFS update for January 1 – March 31, 2015
• Conversion factor of $35.8013
• H.R. 4015/S. 2000 repeals the SGR; institutes a 0.5%
update to Medicare physician payments for five years;
preserves fee-for-service;
• Without intervention CF drops to $28.2239 for April 1 –
December 31, 2015
• Creates a new, non-budget-neutral Merit-Based
Incentive Payment System (MIPS)
• Correction of CMS error in malpractice RVUs results in
reductions of approximately 1% – 2%
• RVU changes will occur on January 1, 2015
• GPCI floor of 1.0 remains through March 31, 2015
Source: ASCRS
Source: CMS 10/31/14
Medicare Conversion Factor
Source: CMS 10/31/14; 2015 CF through 3/31/15
2015 Relative Value Unit Changes
•
•
•
•
•
•
•
•
•
•
•
E/M new patient level 3 (99203)
Intermediate Eye exam (92012)
Comprehensive Eye exam (92014)
SCODI ON/retina (92134)
Intravitreal injection (67028)
Cataract surgery w/IOL (66984)
Gonioscopy (92020)
PPV (67036)
Scleral reinforcement w/ graft (67255)
PPV w/removal of ILM (67042)
PPV w/endolaser PRP (67040)
Percentage change from 2014
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1%
-1%
-2%
-1%
-3%
-4%
-4%
-9%
-23%
-26%
-29%
Executive Summary
Sequestration
• Sequestration ordered as of March 1, 2013
• Reduces Medicare FFS by 2%
• Affects providers, facility, and DME
• Dates of service on or after 4/1/13
• Reduction taken after coinsurance and deductible
• Unassigned claims also subject to reduction
• Medicare EHR incentive payments reduced by 2%
• PQRS and E-Rx 2013 incentive payments reduced by 2%
• Continues through 2023
•
•
•
•
•
•
Payment issues
New codes
Regulatory matters
Administrative changes
Incentive programs
Utilization changes
Source: ASCRS Washington Watch Weekly 3/8/13;
https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/FinalAnnouncement-7-25-2013-NPC-Call.pdf
New / Deleted CPT Codes
• 92145
Corneal hysteresis determination, by air
impulse stimulation, unilateral or bilateral,
with interpretation and report
• Replaces 0181T
New Category III Codes
• 0341T
• 0356T
Quantitative pupillometry with
interpretation and report, unilateral or
bilateral
Insertion of drug-eluting implant (including
punctal dilation and implant removal when
performed) into lacrimal canaliculus, each
Reimbursed in HOPD and ASC as of July
1, 2014
Source: AMA CPT 2015
Source: AMA CPT 2015
New Category III Codes
• 0378T
Visual field assessment, with concurrent real
time data analysis and accessible data
storage with patient initiated data transmitted
to a remote surveillance center for up to 30
days; review and interpretation with report by
a physician or other qualified health care
professional
• 0379T
• 0380T
Computer-aided animation and analysis of
time series retinal images for the monitoring
of disease progression, unilateral or
bilateral, with interpretation and report
technical support and patient
instructions, surveillance, analysis, and
transmission of daily and emergent data
reports as prescribed by a physician or
other qualified health care professional
Source: AMA CPT 2015

New Category III CPT Code
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Source: AMA CPT 2015
CPT Clarification
• Scanning laser ophthalmoscopy (SLO)
• Quantified data – use 92133 or 92134
• Photographic image only – use 92250
ICD-10-CM Deadline
• Final rule for adoption of ICD-10-CM
• Published in January 16, 2009 Federal Register (45
CFR part 162)
• Original Compliance date was October 1, 2013
• Delayed until October 1, 2014
• H.R. 4302 “Protecting Access to Medicare Act of 2014”
• Introduced 3/26/14 by Rep. Pitts (R-PA)
• Passed Senate 3/31/14, Signed by President on 4/1/2014
• Became Public Law 113-93
Source: CPT Assistant, Nov 2014
Source: CONGRESS.GOV
ICD-10 Delayed Again…
• March 31, 2014 - HR 4302 signed by President
Obama
• SGR formula – temporary fix
• ICD-10 delayed … “The Secretary of Health and
Human Services may not, prior to October 1,
2015, adopt ICD-10 code sets as the standard
code sets under section 1173(c) of the SSA and
section 162.1001 of 45CFR”
Targets for Scrutiny
Executive Summary
•
•
•
•
•
•
Payment issues
New codes
Regulatory matters
Administrative changes
Incentive programs
Utilization changes
2015 Part B Annual Deductible
2015 OIG Work Plan
• Place of Service Errors
• Medicare Part B deductible $147
• Payments for drugs
• Unchanged from 2013 / 2014
• Ambulatory Surgical Centers – Payment System
• Effective date 1/1/15
• Ophthalmological Services – Questionable billing during 2012
• Imaging services – Payments for Practice Expense
• Medicare Incentive Payments for Adopting Electronic Health
Records
• Anesthesia services – Payments for personally performed services
• Payment for compounded drugs under Medicare Part B
• Security of Certified Electronic Health Record Technology under
Meaningful Use
Source: HHS OIG FY 2015 Work Plan
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Source: CMS
Medicare Premiums
Part A Deductible
Part B Premium
Levels of Appeal
2013
2014
2015
$1,184
$1,216
$1,260
$104.90
$104.90 $104.90
Co-insurance/day for inpatient stay, days
61-90
$296
$304
$315
Co-insurance/day for inpatient stay, days
>90
$592
$608
$630
Process
Redetermination
Reconsideration
ALJ
Department Appeals
Board
Federal District Court
Days to File Time Limit
120 days
60 days
180 days
60 days
60 days
90 days
60 days
90 days
60 days
AIC1
$0
$0
$150
$0
NA >$1,460
1Amount in controversy; ALJ increased $10 from 2013; Federal Court increased $30
from 2014
Source: HHS.gov Press release 10/9/14
The Physician Payments Sunshine Act
• Requires manufacturers of drugs, medical devices and
biologicals that participate in U.S. federal health care
programs to report certain payments and items of
value given to physicians and teaching hospitals.
• Initial reporting period was August 1, 2013 –
December 31, 2013
Source: http://www.cms.gov/Medicare/Appeals-andGrievances/OrgMedFFSAppeals/index.html
The Physician Payments Sunshine Act
Preparations
1. Register on CMS website to verify data
2. Track internally payments and items of value
received and by whom
3. Be prepared to discuss this with patients
• Subsequent reporting periods will be annual
• Public release date September 30, 2014
Source: https://www.ama-assn.org/ama/pub/advocacy/topics/sunshineact-and-physician-financial-transparency-reports.page
OIG Report on E / M Services
Source: http://www.cms.gov/Regulations-andGuidance/Legislation/National-Physician-Payment-TransparencyProgram/index.html
Improper Medicare FFS Payments
FY 2014
• May 29, 2014 release of report titled: “Improper
payments for evaluation and management services
cost Medicare billions in 2010”
• Part A & B improper payments totaling $45 billion;
12.7% of the dollars processed by CMS
• Improper payments of $6.7 billion
• Part C error rate 9%
• 42% of claims were incorrectly coded
• Medicaid error rate is 6.7%
• Included both upcoding and downcoding
• 19% of claims lacked documentation
Source: http://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf
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Source: http://www.hhs.gov/afr/fy2014-agency-financialreport-final.pdf
Medicare Error Rate (1996 – 2014)
Recovery Audit Program
FY 2010
Oct 2009
– Sept
2010
FY 2011
Oct 2010
– Sept
2011
FY 2012
Oct 2011
– Sept
2012
FY 2013
Oct 2012
– Sept
2013
Total
National
Program
Overpayments
Collected
$75.4M
$797.4M
$2,291.3M
$3,656.8M
$6.8B
Underpayments
Collected
$16.9M
$141.9M
$109.4M
$167.2M
$435.4M
Total Corrections
$92.3M
$939.3M
$2,400.7M
$3,823.8M
$7.26B
Source: CMS Medicare Fee-for Service RAC Program FY 2013
Executive Summary
Recovery Audit Contractors Update
• CMS announced “pause in operations” on February
18, 2014
• Some automated reviews restarted in August 2014
• CMS negotiating new contracts for RACs
• Expect changes in the program
• Name change to Recovery Auditors (RA)
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•
•
•
•
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Payment issues
New codes
Regulatory matters
Administrative changes
Incentive programs
Utilization changes
Source: http://www.cms.gov/Research-Statistics-Data-andSystems/Monitoring-Programs/Medicare-FFS-CompliancePrograms/Recovery-Audit-Program/Recent_Updates.html
CMS Incentive Programs
• Physician’s Quality Reporting System (PQRS)
• Value-based Payment Modifier (VM)
• Health Information Technology (HIT) Incentives
PQRS
• PPACA made PQRS mandatory by 2015
• Bonus payment for 2014 = 0.5%, end of bonuses
• Punitive (-1.5%) if not participating in 2015; -2% in
2016 and beyond
Source: Patient Protection & Affordable Care Act (PPACA)
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PQRS 2015 Options
• Report at least 9 measures via claims and registry-based
reporting covering at least 3 National Quality Strategy
(NQS) domains
• Include 1 measure from cross-cutting measure set (New)
• Report 1-8 measures if less than 9 apply
• Measure Applicability Validation (MAV) process initiated
• Report each measure for at least 50% of the Medicare
Part B FFS patients claims based or with a registry
• Participate in a qualified clinical data registry
Source: CMS Fact sheet 10/31/14; CMS 1612-FC
PQRS 2015
CMS ophthalmic measures
• Primary Open Angle Glaucoma: Optic nerve head evaluation (#12)
• AMD: Dilated macular examination (#14)
• Diabetic Retinopathy: Documentation of presence or absence of
macular edema and level of severity of retinopathy (#18)
• Diabetic Retinopathy: Communication with the physician managing
ongoing diabetes care (#19)
• Eye Exam in Diabetic Patient (#117)
• Age-Related Macular Degeneration (AMD): Counseling on
Antioxidant Supplement (#140)
• Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular
Pressure (IOP) by 15% OR Documentation of a Plan of Care (#141)
Source: CMS 1612-FC
Cross-cutting Measure Set
New Measures PQRS 2015
• Extensive list
• Applicable for ophthalmology and optometry
• Tobacco Use Screening and Cessation Intervention
(#226)
• Documentation of Current Medications in the
Medical Record (#130)
• Preventive Care and Screening: Influenza
Immunization (#110) (Jan – March / Sept – Dec)
• Pneumonia Vaccination Status for Older Adults
(#111)
• Registry Reporting only
• Adult Primary Rhegmatogenous Retinal Detachment
Repair Success Rate (#384) % of surgeries where retina
remains attached after only one surgery
• Adult Primary Rhegmatogenous Retinal Detachment
Surgery Success Rate (#385)
• % of retinal detachment cases achieving flat retinas
six months post-op
Source: CMS 1612-FC
New Measures PQRS 2015
• Registry and Measure Group only
• Cataract Surgery with Intra-Operative Complications
(Unplanned Rupture of Posterior Capsule Requiring
Unplanned Vitrectomy) (#388)
• Cataract Surgery: Difference Between Planned and Final
Refraction (#389)
• % of patients who achieve planned refraction within
+/- 1.0D
Source: CMS 1612-FC
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Source: CMS 1612-FC
PQRS 2015
Cataracts Measures Group
• Increased requirement to all eight measures
• Report for 20 patients, 11 must be Medicare
Reportable by Registry only
• #191 – Cataracts: 20/40 or Better Visual Acuity within 90
days Following Cataract Surgery
• #192 – Cataracts: Complications within 30 Days Following
Cataract Surgery Requiring Additional Surgical Procedures
• #303 – Cataracts: Improvement in Patient’s Visual
Function within 90 Days Following Cataract Surgery
• #304 – Patient Satisfaction Within 90 Days Following
Cataract Surgery
Source: CMS 1612-FC
PQRS 2015
Cataracts Measures Group
New additions to Cataracts measures Group
• #388 – Cataract Surgery with Intra-Operative Complications
(Unplanned Rupture of Posterior Capsule Requiring Unplanned
Vitrectomy) Registry only
• #389 – Cataract Surgery: Difference Between Planned and
Final Refraction Registry only
• #130 – Documentation of Current Medications in the
Medical Record
• #226 – Preventive Care and Screening: Tobacco Use:
Screening and Cessation Intervention
Avoiding 2017 PQRS Penalty
• Satisfy reporting requirements for the 2015 PQRS
program
• No alternative reporting options as in 2013 and 2014
to avoid penalties in 2015 and 2016
• PQRS penalty for 2017 is 2% reduction for PQRS
and 2% - 4% for VBM program
Source: CMS 1612-FC
Value-based Payment Modifier
• Provides for differential payment to a physician or
group under the MPFS based upon the quality of
care furnished compared to cost during a
performance period.
• Program in effect for groups of >10 in 2016; based
on 2014 performance
• Program in effect for all providers in 2017; based on
2015 performance
• Based on participation in PQRS program
Source: http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PhysicianFeedbackProgram/ValueBasedPaymentModifi
er.html
Potential Financial Penalties
CY 2014 is the performance period for the Value
Modifier that will be applied in CY 2016. In order to
avoid an automatic negative two percent (“-2.0%”)
Value Modifier payment adjustment in CY 2016, EPs
in groups of 10 or more MUST participate in and
satisfy the Physician Quality Reporting System
(PQRS) requirements as a group or as individuals in
CY 2014
Source: http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html
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Quality Resource Use Reports
• QRUR is confidential feedback report for those billing
fee-for-service
• Clinical quality measures derived from claims
• Individual physician performance on quality measures
• Overall costs for patients whose care a physician
directed, contributed to or influenced
• Per capita costs for patients with diabetes, coronary
artery disease, chronic obstructive pulmonary disease
and heart failure
• QRURs contain quality of care and cost performance
rates on measures that will be used to compute the value
based payment modifier
Sources: http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PhysicianFeedbackProgram/2012-QRUR.html
Value Modifier Payment Adjustments
In CY 2017, CMS will apply a maximum downward
adjustment of -2.0 percent for groups with two to nine
EPs and solo practitioners, if the group or solo
practitioner does not meet the quality reporting
requirements for the PQRS.
Source: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2014-Fact-sheets-items/2014-10-315.html?DLPage=1&DLSort=0&DLSortDir=descending
Value Modifier Payment Adjustments
. . .for CY 2017 payments, a -4.0 percent Value Modifier
adjustment will apply to groups of ten or more EPs
subject to the Value Modifier that do not meet the quality
reporting requirements for the Physician Quality
Reporting System (PQRS).
Solo providers and Groups with < 10 EPs
Cost / Quality Low Quality
Average Quality High Quality
Low Cost
+0.0%
+1.0x
+2.0x
Average Cost
+0.0%
+0.0%
+1.0x
High Cost
+0.0%
+0.0%
+0.0%
X represents payment adjustment factor which will be determined at the end of
CY 2015
ASCRS / ASOA & AAO
Source: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2014-Fact-sheets-items/2014-10-315.html?DLPage=1&DLSort=0&DLSortDir=descending
Health Information Technology (HIT)
VBPM 2015
Groups with > 10 EPs
Cost / Quality Low Quality
VBPM 2015
Average Quality High Quality
Low Cost
+0.0%
+2.0x
+4.0x
Average Cost
-2.0%
+0.0%
+2.0x
High Cost
-4.0%
-2.0%
+0.0%
• Component of the American Recovery and Reinvestment
Act
• Penalties begin in 2015 if not participating
• Requires “meaningful use” of healthcare IT
• Certified EHR technology
• Information exchange
• Reporting of measures using EHR
X represents payment adjustment factor which will be determined at the end of
CY 2015
ASCRS / ASOA & AAO
Timeline
• Began in 2011 and will continue through 2016.
EHR Incentive Program
Medicare Incentive Payments
• Last year to begin participation was 2014.
*Program-to Date
Providers Paid
*Program-to
Date Payment
Amount
Total Eligible Professionals
483,167
$6.47B
Ophthalmologists
12,945
$187M
Optometrists
21,394
$261M
• To qualify for EHR incentive payments, must
successfully demonstrate and attest to meaningful
use for each year of participation.
*Medicare payments began in May 2011; information as of September 2014;
Source: www.cms.gov/EHRIncentivePrograms
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Financial Penalties
Financial Penalties
Percentage adjustment assuming less than 75% of
eligible professionals are meaningful users
2015 2016 2017 2018 2019
Percentage adjustment assuming more than 75% of
eligible professionals are meaningful users
2020+
2015 2016 2017 2018 2019
Eligible professional is not subject to the
payment adjustment for the e-Rx in 2014
99%
98%
97%
96%
95%
95%
Eligible professional is not subject to the
payment adjustment for the e-Rx in 2014
99%
98%
97%
97%
97%
97%
Eligible professional is subject to the payment
adjustment for the e-Rx in 2014
98%
98%
97%
96%
95%
95%
Eligible professional is subject to the payment
adjustment for the e-Rx in 2014
98%
98%
97%
97%
97%
97%
Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals
Last Updated: March 2014
Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals
Last Updated: March 2014
Stages of Meaningful Use
Year
2011
2012
2013
2014
2015
2011
1
2012
2013
2014
2015
Changes to Meaningful Use
2016
2017
1
1
2
2
32
3
1
1
2
2
32
3
1
1
2
2
3
1
1
2
2
1
1
2
1
1
2016
1
2017
Source: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Pressreleases/2014-Press-releases-items/2014-05-20.html
Hardship Exceptions
• Infrastructure: Eligible professionals must demonstrate
that they are in an area without sufficient internet access
or face insurmountable barriers to obtaining
infrastructure (e.g., lack of broadband).
• New Eligible Professionals: Newly practicing eligible
professionals who would not have had time to become
meaningful users can apply for a 2-year limited exception
to payment adjustments. Thus eligible professionals who
begin practice in calendar year 2015 would receive an
exception to the penalties in 2015 and 2016, but would
have to begin demonstrating meaningful use in calendar
year 2016 to avoid payment adjustments in 2017.

2020+
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You are able to attest for MU:
If you were
scheduled to
demonstrate:
Using 2011 Edition
CEHRT to do:
Stage 1 in 2014
2013 Stage 1
objectives and
measures
Stage 2 in 2014
2013 Stage 1
objectives and
measures
Using 2011 & 2014 Edition
CEHRT to do:
Using 2014 Edition
CEHRT to do:
2013 Stage 1 objectives
and measures
2014 Stage 1
-orobjectives and
2014 Stage 1 objectives
measures
and measures
2013 Stage 1 objectives
2014 Stage 1
and measures
objectives and
-OR2014 Stage 1 objectives
measures
-ORand measures
Stage 2 objectives and
-ORmeasures
Stage 2 objectives and
measures
Source: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Pressreleases/2014-Press-releases-items/2014-05-20.html
Hardship Exceptions
• Unforeseen Circumstances: Examples may include a
natural disaster or other unforeseeable barrier.
• Patient Interaction:
• Lack of face-to-face or telemedicine interaction with patient
• Lack of follow-up need with patients
• Practice at Multiple Locations: Lack of control over
availability of CEHRT for more than 50% of patient
encounters
• 2014 EHR Vendor Issues: The eligible professional’s
EHR vendor was unable to obtain 2014 certification or the
eligible professional was unable to implement meaningful
use due to 2014 EHR certification delays.
EMR, MU2, and Scribes
Official CMS EHR Website
• Meaningful Use Core Measure 1
• A licensed healthcare professional enters orders into
an electronic medical record for purposes of satisfying
CPOE objective in MU2, or…
• A credentialed medical assistant enters medication
(>60%), radiology (>30%), and laboratory (>30%)
orders into EHR to satisfy MU2 thresholds
• COA, COT, COMT, CO, CMA are certified and
credentialed medical assistants
• ACMSS certified scribe (CMSS)
• AAMA credentialed scribe for assessment-based
recognition in order entry
• Description of Incentive Program
• Calendar of important dates
• Official information
• CMS.gov → Regulation & Guidance → EHR
Incentive
• http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/index.
html?redirect=/EHRIncentivePrograms/30_Meaningf
ul_Use.asp
Source: CMS, MU2 Measure 1, October 2012
56
Executive Summary
Changes to Practice Patterns
Optometry (41)
•
•
•
•
•
•
Payment issues
New codes
Regulatory matters
Administrative changes
Incentive programs
Utilization changes
Increases
Decreases
•
•
•
•
•
•
•
• Nursing home (99310)
• Level 5 E/M (992x5)
ERG (92275)
+7927%
Tear osmolarity (83861) +387%
VEP (95930)
+111%
OCT, anterior (92132)
+30%
OCT, retina (92134)
+19%
B-Scan (76512)
+18%
Topography (92025)
+11%
Source: CMS data 2012 vs. 2013, 41 - Optometry
Top 10 Optometric Procedures
Summary
Medicare Utilization Patterns Optometry (41)
Rank
CPT
Procedure
Rank
CPT
Procedure
1
92250 Fundus Photo
6
92226 EO, subsequent
2
92083 Perimetry
7
92020 Gonioscopy
3
92133 SCODI – nerve
8
68761 Punctum plug
4
92134 SCODI – macula
9
92285 External photo
5
92225 EO, initial
10
76514 Pachymetry
Source: CMS data 2013, 41 - Optometry
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• 2015 reimbursement rates minimally changed for
first quarter
• Several code changes
• More scrutiny of Medicare program integrity
• Numerous administrative changes
• Continued growth in many ophthalmic services
-15%
-11%
DIAGNOSTIC TESTS
Outline
1. Supervision
2. Interpretation and Report
3. Case studies
Diagnostic Test Challenges
Kirk A. Mack, COMT, CPC, COE
Senior Consultant
Corcoran Consulting Group
Common Ophthalmic Tests
Supervision
Medicare Utilization Patterns (41 - Optometry)
• General supervision
CPT
Procedure
92250 Fundus Photo
λ
13%
CPT
Procedure
92133 Scanning Laser
9208x Perimetry
10%
92134 Scanning Laser
λ
6%
• Physician reviews notes
• Direct supervision
(glaucoma)
5%
(retina)
9222x Ext Ophthalmoscopy
92020 Gonioscopy
6%
2%
92285 External Photo
76514 Pachymetry
• Physician immediately available
• Personal supervision
1%
1%
• Physician in the room
Frequency is per 100 office visits (%) on Medicare beneficiaries
Source: CMS data (2013), 41 – Optometry
General Supervision
•
•
•
•
•
•
•
•
•
•
•
Perimetry
Fundus photography
External ocular photography
Scanning computerized ophthalmic diagnostic imaging
Orthoptics
Extended color vision testing
Dark adaptation exam
Visual evoked potential (VEP) done by certified tech
A-scan biometry
Specular endothelial microscopy and cell count
Pachymetry
Source: CMS MPFS
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Direct Supervision
•
•
•
•
•
•
•
•
Fluorescein angiography
ICG angiography
A-scans (tumors)
Immersion B-scan, high resolution biomicroscopy
Contact B-scan
Visual evoked potential (VEP) done by non-certified tech
Electro-oculography (EOG)
Electroretinography (ERG)
Source: CMS MPFS
Personal Supervision
• Oculoelectromyography (OEM)
Medicare Test Policy
42 CFR §410.32 Diagnostic X-ray tests, diagnostic laboratory
tests, and other diagnostic tests: Conditions.
(a) Ordering diagnostic tests. All diagnostic x-ray tests,
diagnostic laboratory tests, and other diagnostic tests must
be ordered by the physician who is treating the beneficiary,
that is, the physician who furnishes a consultation or treats a
beneficiary for a specific medical problem and who uses the
results in the management of the beneficiary's specific
medical problem. Tests not ordered by the physician who is
treating the beneficiary are not reasonable and necessary.
Source: CMS MPFS
Diagnostic Test Order
• Tests are ordered by the physician for a medically
appropriate reason, generally after the eye exam
• Technicians cannot order tests
• Order may be scribed by staff on physician’s direction
• “VF for COAG next visit per Dr. Smith”
• Standing orders are not reimbursed
What’s Appropriate?
Dr. Optometry instructs the technician to dilate all new
patients upon arrival and perform: OCT of optic nerve OU,
FP OU, and 24-2 HVF. Which of the following apply?
What’s Appropriate?
Dr. Optometry instructs the technician to dilate all new
patients upon arrival and perform: OCT of optic nerve OU,
FP OU, and 24-2 HVF. Which of the following apply?
a) These tests are billable only if the physician in the
office
b) The physician has given “standing orders”
c) The tests cannot all be performed on the same day
d) Reimbursement depends on the interpretation of
each test
Testing During Postop Period
• Services not included in the global surgery package:
• Diagnostic tests and procedures, including diagnostic
radiological procedures
• Examples:
b) The physician has given “standing orders”
• Testing unrelated to the prior surgery
• Testing to evaluate an unfortunate outcome
• Testing to prepare for another surgery
• Not covered: testing to confirm the expected outcome
Source: MCPM, Chapter 12, §40.1B
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Testing Following Surgery
Six weeks after a cataract surgery, the co-managing
optometrist orders an OCT to confirm CME. The OCT
shows CME. The tests are not part of the global
package and are billable.
a) True
b) False
Testing Following Surgery
Six weeks after a cataract surgery, the co-managing
optometrist orders an OCT to confirm CME. The OCT
shows CME. The tests are not part of the global
package and are billable.
a) True
Chart Documentation
• ….with interpretation and report
Interpretation & Report
“Carriers generally distinguish between an ‘interpretation
and report’ of an x-ray or an EKG procedure and a
‘review’ of the procedure. A professional component
billing based on a review of the findings of these
procedures, without a complete written report similar to
that which would be prepared by a specialist in the field
does not meet the conditions for separate payment of
the service. This is because the review is already
included in the … E/M payment.”
Source: CMS MCPM Chapter 13, §100
Interpretation & Report
“For example, a notation in the medical records saying
‘fx tibia’ or ‘EKG-normal’ would not suffice as a
separately payable interpretation and report of the
procedure and should be considered a review of the
findings payable through the E/M code. An
‘interpretation and report’ should address the findings,
relevant clinical issues, and comparative data (when
available).”
Test Interpretation
• What does it show?
• Increased blind spot
• What does it mean?
• Progression of glaucoma
• What are you going to do about it?
• Add a medication
Source: CMS MCPM Chapter 13, §100
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Visual Field Interpretation
Illustrative Test Interpretation
• Plan: Threshold perimetry to re-evaluate POAG
TEST: Visual Field Humphrey 24-2
•
•
•
•
•
•
•
October 10, 2012
Mary Smith, COA
1 false positive
Good patient cooperation
Arcuate scotoma, OU
POAG, shows progression since last visit
Add another anti-glaucoma medication
Interpretation: Stable VF
Dx:
What’s wrong?
POAG
I. C. Better, O.D.
Illustrative Test Interpretation
Illustrative Test Interpretation
TEST: Visual Field Humphrey 24-2
TEST: Visual Field Humphrey 24-2 for Glaucoma
Interpretation: Stable VF
Interpretation: Enlarged blind spot OD. No change from
previous visual field 6 months ago. Continue current
treatment.
Dx:
POAG
What does stable mean?
Compared to what?
Previous test findings?
Dx:
Illustrative Test Interpretation
TEST: Optic nerve OCT
Interpretation: Normal
Dx:

POAG
Improved Interpretation
Illustrative Test Interpretation
TEST: Optic nerve OCT
What’s wrong?
POAG
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Interpretation: Normal
Dx:
POAG
Why was test done?
Observations?
Data?
Illustrative Test Interpretation
Illustrative Test Interpretation
TEST: Optic nerve OCT
TEST: Optic nerve OCT
Interpretation: OCT for POAG. No retinal nerve fiber
layer loss or changes at this time. No treatment
indicated.
Interpretation: POAG OU
Dx:
POAG
Dx:
POAG
Improved Interpretation
Illustrative Test Interpretation
TEST: Optic nerve OCT
Interpretation: POAG OU
Dx:
What’s wrong?
POAG
Illustrative Test Interpretation
TEST: Optic nerve OCT
What does the
OCT show?
Interpretation: Reduced NFL, inferior and nasal
quadrants OD>>OS. Progression OD>OS over 6 mo.
Add a medication.
Dx:
POAG
Improved Interpretation
Illustrative Test Interpretation
TEST: Macula OCT
Interpretation:
Dx:
CMT* 183 OD
CMT* 245 OS
TEST: Macula OCT
What’s wrong?
Dry AMD OD
Wet AMD OS
*CMT = Central Macula Thickness

Illustrative Test Interpretation
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Interpretation:
Dx:
CMT 183 OD
CMT 245 OS
Dry AMD OD
Wet AMD OS
What do 183 &
245 mean?
Compared to past
tests?
Illustrative Test Interpretation
Illustrative Test Interpretation
TEST: Macula OCT
TEST: Corneal Pachymetry
Interpretation:
OCT OU to follow AMD. OD dry
AMD no edema, CMT stable with previous test. OS
Wet AMD with edema. CMT worse from previous
test. Refer to Dr. Retina.
Interpretation:
Dx:
554
548
What’s wrong?
POAG
Improved Interpretation
Dx:
Dry AMD OD
Wet AMD OS
Illustrative Test Interpretation
TEST: Corneal Pachymetry
Interpretation:
Dx:
554
548
TEST: Corneal Pachymetry for Glaucoma
What do the
Readings mean?
Interpretation:
Dx:
POAG
Test Interpretation
• Create a template/form for diagnostic tests
• Paper or EMR require the same information
• Follow same approach for dictation
• Separate interpretation for each test
• Separate interpretation for each eye for unilateral tests
• 92225, 92226

Illustrative Test Interpretation
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POAG
554 OD, 548OS – Average Corneal
thickness. IOP as stated.
Improved Interpretation
Question
• Q: How many OCTs can I order per year with
Glaucoma and Retina pathology?
Medicare’s Coverage Policy
Medicare’s Coverage Policy
92133 – SCODI-P for Optic Nerve
92134 – SCODI-P for Retina
• Preglaucoma or mild damage
• Early detection of glaucoma
• One test per year
• Moderate damage
• One or two tests per year 1
• Advanced damage
• Rare indication for SCODI
• Not more than 4 VFs per year
Source: Sample LCD
"It is expected that no more than four (4) tests per year would be
appropriate with the following exceptions. Patients with retinal conditions
undergoing active intravitreal drug treatment may be allowed one scan
per month per eye. These conditions include age-related macular
degeneration (wet), choroidal neovascularization, macular edema,
diabetic retinopathy (proliferative and non-proliferative), branch retinal
vein occlusion, central retinal vein occlusion, and cystoid macular
edema. In addition, other conditions which may undergo rapid clinical
changes monthly requiring aggressive therapy and frequent follow-up,
such as macular hole and traction retinal detachment, may also require
monthly scans."
Source: Sample LCD
Medicare’s Coverage Policy
Posterior Segment OCT (92133/92134)
• Diagnose and manage medically and surgically retinal and neuro-ophthalmic
diseases which involve changes in the optic nerve, subretinal and intraretinal
changes, vitreo-retinal relationships and changes in the nerve fiber layer.
• Diagnose early glaucoma and monitor glaucoma treatment
• Differentiate causes of other optic nerve disorders when a diagnosis is in doubt.
• Diagnose and manage the patient's condition when visual field results are
insufficient; or when reliable visual field testing cannot be performed, due to
visual, physical, mental, or age constraints.
• Differentiate when a discrepancy exists between the clinical appearance of the
optic nerve and the visual fields.
• Detect further loss of optic nerve or retinal nerve fiber layer changes in the
presence of advanced optic nerve damage and advanced visual field loss.
• Follow glaucoma suspects
Question
• Q: Can we take baseline fundus photos of
diabetic patients without retinopathy?
• A: No
Source: Sample LCD
Medicare’s Coverage Policy
92250 Fundus Photography
• Fundus photography is usually medically necessary no
more than two times per year.
• Fundus photography of a normal retina will be
considered not medically necessary.
• Services exceeding these parameters will be considered
not medically necessary.
Source: Sample LCD
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Question
• Q: Can you bill for extended ophthalmoscopy
(92225/92226) with EHR if you do not draw?
Medicare’s Coverage Policy
9222x Extended Ophthalmoscopy
• Extended ophthalmoscopy is the detailed examination of
the retina and always includes a true drawing of the
retina, with interpretation and report. It is most
frequently performed utilizing an indirect lens…
• If indirect ophthalmoscopy is done without a drawing or
does not meet the standards indicated, the service is not
separately payable and will be considered part of a
general ophthalmologic exam (92002-92014) or E&M
service.
Source: Sample LCD
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ICD-10 UPDATE
ICD-10-CM Deadline
• Final rule for adoption of ICD-10-CM
ICD-10-CM Overview
• Published in January 16, 2009 Federal Register (45
CFR part 162)
• Original Compliance date was October 1, 2013
• Delayed until October 1, 2014
Kirk A. Mack, COMT, COE, CPC, CPMA
Senior Consultant
Corcoran Consulting Group
• H.R. 4302 “Protecting Access to Medicare Act of 2014”
• Introduced 3/26/14 by Rep. Pitts (R-PA)
• Passed Senate 3/31/14, Signed by President on 4/1/2014
• Became Public Law 113-93
Source: CONGRESS.GOV
House Resolution 4302
SEC. 212. DELAY IN TRANSITION FROM ICD–9
TO ICD–10 CODE SETS.
The Secretary of Health and Human Services may
not, prior to October 1, 2015, adopt ICD–10 code
sets as the standard for code sets under section
1173(c) of the Social Security Act (42 U.S.C.
1320d–2(c)) and section 162.1002 of title 45, Code
of Federal Regulations.
Source: H. R. 4302
ICD Updates
• October 1, 2014 and October 1, 2015 – only limited
code updates to both the ICD-9-CM and ICD-10 code
sets to capture new technologies and diseases
• No updates to ICD-9-CM, as it will no longer be used for
reporting to HIPAA-covered entities
• October 1, 2016 – regular updates to ICD-10 will begin
Source:
http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf
ICD-10 “Test Claims” Weeks
• Three week-long testing dates
• November 17 – 21, 2014
• March 2 – 6, 2015
• June 1 – 5, 2015
• Physicians, other providers, DME, HH
• Submit with current DOS
• Subject to existing NPI validation edits
• MACs CEDI will have ↑ staff available to answer calls
• Claims receive acknowledgement codes:
• 277CA if received AND accepted
• 999 received BUT rejected
• No Remittance advice generated
Source: MedLearnMatters, MM 8858, 8/22/14
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Compare and Contrast
ICD-10
ICD-9
• 17 Chapters
• 21 Chapters
• 14,000 codes
• ~ 69,000 codes
• 3-5 digits
• 3-7 digits
• First digit is numeric or
alpha (E or V)
• Digit 1 is alpha
• Digits 2-5 are numeric
• Digits 3-7 are alpha or
numeric (alpha digits are not
• Digit 2 is numeric
case sensitive)
ICD-10 Example
Tabular List
• 366.16 – Nuclear sclerotic cataract (senile)
• H25.1 Age-related nuclear cataract
Cataracta brunescens
Nuclear sclerosis cataract
H25.10
Age-related nuclear cataract, unspecified eye
H25.11
Age-related nuclear cataract, right eye
H25.12
Age-related nuclear cataract, left eye
H25.13
Age-related nuclear cataract, bilateral
• Categories
• 3 characters – Chapter 7 – Disorder of the Eye
and Adnexa (H00-H59)
• Subcategories
• 4th character further defines site, etiology,
manifestation or state of disease or condition
• 5th & 6th character increases specificity
7th Character Extension
Tabular List
• 7th Character Extension
• Some categories have applicable
7th
characters
• Last character
• A
• D
• S
initial encounter
subsequent encounter
sequela
• If code is not six digits, use “x” as placeholder
• “x” as placeholder
• For when characters are needed for expansion
Example
Corneal Abrasion
Example
Corneal Abrasion
• Category – Chapter 19 – Injury, Poisoning . . .
S05 – Injury of eye and orbit
• Subcategory –  5th S05.0 – Injury of conjunctiva and
corneal abrasion without foreign body
• Specificity –  x 7th S05.01 – Injury of conjunctiva and
corneal abrasion without foreign body right eye
• Valid code – S05.01xA -- Injury of conjunctiva and
corneal abrasion without foreign body right eye; initial
encounter
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7th Character Extension
For glaucoma staging, 7th denotes severity of disease
• 0 = unspecified (not noted in chart)
• 1 = mild
• 2 = moderate
• 3 = severe
• 4 = indeterminate (unknown)
Example: Glaucoma Staging
7th character “is to be assigned to each code in
subcategory H40.12 to designate the stage of glaucoma”
• Low-tension Glaucoma
• H40.12
• Low-tension Glaucoma, bilateral
(cannot stop here!)
• H40.123
• Low-tension Glaucoma, right eye, moderate stage
• H40.1212
• Low-tension Glaucoma, left eye, severe stage
• H40.1223
Terminology
“Laterality”
Laterality
• Right and left designation • Example
1 = right
H25.11 Age-related
nuclear cataract, right eye
2 = left
3 = bilateral
H25.12 Age-related nuclear
cataract, left eye
0 or 9 = unspecified
H25.13 Age-related nuclear
cataract, bilateral
H25.10 Age-related
nuclear cataract,
unspecified eye
Terminology
Ch. 4: Endocrine, Nutritional, and
Metabolic Diseases (E00-E89)
“Laterality”
Exception example (diseases of eyelids)
• H02.011 Cicatricial entropion of right upper eyelid
• H02.012 Cicatricial entropion of right lower eyelid
• H02.013 Cicatricial entropion of right eye,
unspecified eyelid
• H02.014 Cicatricial entropion of left upper eyelid
• H02.015 Cicatricial entropion of left lower eyelid
• H02.016 Cicatricial entropion of left eye,
unspecified eyelid
• H02.019 Cicatricial entropion of unspecified eye,
unspecified eyelid
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•
Diabetes mellitus
• Combination codes that include
• Type of diabetes mellitus
• Body system affected
• Complications affecting body system
• Sequenced based on reason for encounter
Diabetes Mellitus
Diabetes Mellitus
Insulin use
• Five diabetes mellitus categories
• E08 Diabetes mellitus due to an underlying
condition
• E09 Drug or chemical induced diabetes mellitus
• E10 Type 1 diabetes mellitus
• E11 Type 2 diabetes mellitus
• E13 Other specified diabetes mellitus
• All categories except E10 (Type 1 DM) require use
of additional code to indentify any insulin use
• Z79.4 – Long term (current) use of insulin
*Use E11 if record does not indicate type of DM, but
does indicate insulin use.
Sources: 1. ICD-10 Official Guidelines, Sect C Chapter specific guidelines; 4.a.3
Compare and Contrast
ICD-10
ICD-9
Example:
• Mild NPDR, no DME –
362.04
• DM with ophthalmic
manifestation, not stated
as uncontrolled - 250.50
Example:
• Type II DM with mild
NPDR w/o macular
edema - E11.329
Documentation Upgrade
• Begin now
• Review notes for services previously coded and billed
• Determine if notes are is adequate to support an ICD-10
selection
• Use your findings to make changes
• Forms and templates
• Patient interviews
• Technician, scribe and physician documentation
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Diabetes Mellitus
Examples
• E11.9
Type 2 DM without complications
• E10.339 Type 1 DM with moderate NPDR without
macular edema
• E11.321 Type 2 DM with mild NPDR with
macular edema
&
• Z79.4
Long-term current use of insulin (if
documented)
Documentation Considerations
• Laterality
• Is your assessment specific to which eye or
eyelid?
• Etiology / Manifestation
• Does your chart note list both the disease and
the associated manifestation?
• Specificity
• Is the impression as specific as possible for a
particular condition?
Documentation Considerations
Documentation Considerations
History
Impression
New
Old
New
Old
• Diabetic
• Type II diabetes on insulin
• Chalazion OS
• Cataract OD from
injury
• Cataract OD caused by
driver side airbag
• BDR OU
• Hypertension
• Hypertension; history of
tobacco use
• HIV positive
• Asymptomatic HIV
• Chalazion LLL
• Type II diabetes with mild
NPDR w/out macula
edema; taking insulin
• Iritis OU
• Hyphema OD
• No maculopathy
Common Patient Syndromes
R46.0 – Low level of
personal hygiene
R19.6 – Halitosis (bad
breath)
• Chronic iritis OU
• Traumatic hyphema OD
• RA taking plaquenil; no
ocular disease
Key Points in Preparation
• CMS files / GEMS files
• Smart Phone or tablet apps
• Websites
• Text book (be sure it’s 2013 or later)
“GEM”
GEM File Layout
Senile Cataract Example
• General Equivalence Mappings
• GEM file is NOT a crosswalk, it is a mapping
• Two sets of files
• ICD-9 to ICD-10
• ICD-10 to ICD-9
• Each file contains “code pairs” – one from each set
• Expect annual update of files
• Eye codes translation is fairly straightforward
I-9 
36610
36611
36612
36613
36614
36615
36616
36617
I-10 + Flags
H259
H2589
H25099
H25039
H25049
H25019
H2510
H2589
“1” in the first position in flag column = approximate
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00000
10000
10000
10000
10000
10000
10000
10000
Useful Aids
• “Apps”
• Apple – iPhone and iPad
• Android (phone and tablet)
• Windows Phone
• Popular options from previous attendees
• ICD-10 Find-A-Code
• icd10data
• Supercoder.com
Transitioning to ICD-10
1. Notify everyone that this is coming
a) High level overview
b) Secure acceptance from everyone that changes
need to be made
c) Recruit leaders from each area of practice to help
with implementation
2. Analyze areas that require significant changes
Other Useful Aids
•
•
•
•
•
www.cms.gov/ICD10/
www.ahima.org
www.cdc.gov/nchs/icd.htm
www.who.int/en/
AAPC Code Translator
• http://www.aapc.com/ICD-10/codes/index.aspx
• Others
• http://www.icd10data.com/
Transitioning to ICD-10
3. Create a timeline
a) Talk to computer vendor
4. Develop new policies and processes
a) Consider all policies / processes linked to diagnosis
codes (PQRS, pre-authorizations, chart reviews)
b) Create training materials
c) Build “route slip” or other tool(s) for code selection
a) Documentation by physicians and staff
b) Billing office
Transitioning to ICD-10
5. Train physicians and staff
a) Emphasize anatomy, physiology, and medical
terminology to select ICD-10 code
• Practice early, practice often!
• You are asking people to change habits or patterns
• This takes time and practice
b) New policies and procedures
• Continue reporting ICD-9 for claims submission
c) Changes to software
• “Double code” a few of claims with ICD-10 codes
6. Test your preparedness in all areas with enough
time to fix issues before 10/1/15

Begin Using ICD-10 Codes
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• Compare your answers with each other
• Use for training and glossary most common codes
Begin Using ICD-10 Codes
• Divide tasks in to workable segments
What Next?
• refractive error and cataract codes
Review the documentation for your most
commonly used diagnosis codes.
• glaucoma
Improve where necessary!
• cornea and external eye codes (plastics)
Work with EMR
Now
• retina and diabetes code
• Injuries and infections
• Use this time to assess tools available to you
• Apps, websites etc
Soon
Start coding a small sample of services with
ICD-9 and ICD-10
Get staff training
• Use this time to educate staff
Make sure they put it to work!
• History taking, documentation, anatomy
Examples
•
•
•
•
•
Cataract
CC: cataracts, OU, slow decrease VA during
past 6 mos, trouble reading, glare worsening
Dx: Nuclear sclerotic cataracts OD>OS
Tx: Refer to cataract surgeon for evaluation
Cataract
PCO
COAG
Blepharochalasis
BDR
366.16 Nuclear Sclerotic Cataract
What is the appropriate ICD-10 code?
Cataract
CC: Cataracts, OD, slow decrease VA during
past 6 mos, trouble reading, glare worsening
Dx: Nuclear sclerotic cataracts OD>OS
Tx: Refer to cataract surgeon for evaluation
Secondary Cataract
CC: Pseudophake OS, 2 years ago, great
difficulty with reading small print
Dx: Posterior capsular Opacification (PCO), OS,
obscuring vision
Tx: Recommend YAG OS
H25.13 NS, Cataract, OU
366.53 After cataract, obscuring vision
What is the appropriate ICD-10 code?
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Secondary Cataract
CC: Pseudophake OS, 2 years ago, great
difficulty with reading small print
Dx: Posterior capsular Opacification (PCO), OS,
obscuring vision
Tx: Recommend YAG OS
Chronic Open Angle Glaucoma
CC: IOP for Chronic Open Angle Glaucoma OU
Dx: Uncontrolled COAG OU ; “severe” VF loss OD,
“moderate” VF loss OS
Test: HVF 24-2
365.11 Primary Open Angle Glaucoma
H26.492
Z96.1
Other 2nd cat, OS
Presence of IOL
Chronic Simple Glaucoma
365.73 Severe stage glaucoma
What is the appropriate ICD-10 code(s)?
Chronic Open Angle Glaucoma
Blepharochalasis
CC: IOP for Chronic Open Angle Glaucoma OU
Dx: Uncontrolled COAG OU ; “severe” VF loss OD,
“moderate” VF loss OS
Test: HVF 24-2
CC: Difficulty with upper field of vision, worsening
H40.11x3 POAG, Severe stage (no laterality)
H40.11x2 POAG, Moderate stage (no laterality)
H53.40
Unspecified visual field defects
374.34
gradually past 2 yrs
Dx: Blepharochalasis, both UL
What is the appropriate ICD-10 code(s)?
Blepharochalasis
CC: Difficulty with upper field of vision, worsening
gradually past 2 yrs
Dx: Blepharochalasis, both UL
H02.31
H02.34
Blepharochalasis, right upper lid
Blepharochalasis, left upper lid
Blepharochalasis
Strabismus Operative Note
• You are reviewing the op note for a strabismus case
done earlier today. You note it was for exotropia, OD and that two horizontal muscles of the right eye were
operated upon.
378.11
Monocular exotropia
What is your ICD-10 code(s)?
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Slides\2015\022115_KAM_ESG_Memhis TN\OD Meeting_022115
Strabismus Operative Note
• You are reviewing the op note for a strabismus case
done earlier today. You note it was for exotropia, OD and that two horizontal muscles of the right eye were
operated upon.
H50.111
Monocular exotropia, right eye
Background Diabetic Retinopathy
CC: Recently Dx Diabetes (Type II), needs exam
Dx: 1) Diabetes (Note: on oral hypoglycemics only)
2) Mild non-proliferative DR, OU
Tx: Letter to PCP/Endocrinologist, Control Blood
sugars
Recheck 1 yr
250.50
362.04
DM w/ mention of complication,
not stated as uncontrolled
Mild NPDR
What is the appropriate ICD-10 code(s)?
Background Diabetic Retinopathy
CC: Recently Dx Diabetes (Type II), needs exam
Dx: 1) Diabetes (Note: on oral hypoglycemics only)
2) Mild non-proliferative DR, OU
Tx: Letter to PCP/Endocrinologist, Control Blood sugars
Recheck 1 yr
E11.329

Type II DM with mild NPDR w/o
macular edema
2015 Corcoran Consulting Group (800) 399-6565 www.corcoranccg.com
Slides\2015\022115_KAM_ESG_Memhis TN\OD Meeting_022115