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  • Diabetic Cataract Patient

    Question: A physician ordered an OCT to confirm the retina of a diabetic cataract patient was normal and not contributing to poor vision. Can we bill if pathology is found? 

    Answer: The OCT is not billable to the patient or the payer even if pathology is found when performed as a screening test. The cost is absorbed by the practice. E10.9 (Type 1) and E11.9 (Type 2) diabetes mellitus without complications is not a covered diagnosis by most payers.

    CMS has specified that the only expenses that you can ask a patient to pay out of pocket are associated with premium intraocular lenses (IOLs) or when astigmatism-correcting corneal incisions are performed.

    Cataract Controversies — Answers to Contentious Coding Questions