EyeMed Updates

Expanded diagnosis reporting now available December 20, 2016

CPT II codes now available on online claims system.

EyeMed works with a growing number of health plans to administer their routine vision benefits. Many of these clients look to us for reporting about the number of members with high- risk conditions who are receiving routine vision care from you. Now, we’ve expanded the available codes for disease reporting to include category II CPT codes so you can supply additional details about patients’ current conditions.

The additional codes do not define the service and should not be used without a primary ICD-10 diagnosis code. The purpose is to provide additional information about the conditions, particularly in cases where there is no evidence of eye-related symptoms related to diabetes or other high- risk conditions.

You’ll see CPTII codes available as options when entering the eye exam claim. Your selected conditions will also display later in the claims process.

You might recall we require you to enter diagnoses for anyone you treat who happens to have abnormal pupil, ARMD, cataract, diabetes, diabetic retinopathy, glaucoma, hypercholesterolemia or hypertension – even though you’re treating them for routine vision services in the context of our plans. When seeing patients with diabetes, don’t forget to code the risk of retinopathy even if it isn’t already apparent, using E11.8 / E11.9.

Our provider manual provides more information about this requirement.