How to Improve Diabetic Eye Exams

By: AvMed News AvMed News

AvMed Members between the ages of 18 and 75 who have a diagnosis of type 1 or type 2 diabetes should receive an annual dilated retinal eye exam. The exam can help identify diabetic retinal disease, allowing physicians to treat it sooner and prevent severe vision loss.

As a Provider, there are several ways you can help improve retinal eye exams:

Use the Right Codes

Make sure all services are coded correctly to avoid billing and compliance issues. Screening or monitoring for diabetic retinal disease is identified by administrative claims data or medical record review, and includes:

  • A retinal or dilated eye exam by an optometrist or ophthalmologist in the measurement year
  • A negative retinal or dilated eye exam (negative for retinopathy) by an optometrist or ophthalmologist in the year before the measurement year
  • Bilateral eye enucleation anytime during the patient’s history through December 31 of the measurement year

Get Organized

Consider assigning a staff member to add reports to patients’ charts. If your practice uses electronic medical records, use flags or system reminders to alert staff when screenings are due. If your practice uses hard-copy charts, consider a template to identify the last date of all necessary screenings, as well as the next time patients should be screened. Be proactive: Call patients to remind them of screenings and send appointment reminders as well.

Address Care Gaps

If you have a copy of the eye exam in your office chart but the patient has an open care gap, you may file an informational (zero-dollar) claim to close the gap; file a claim for $0 for the date of the exam; and use the appropriate CPT category II code.

Have questions? For answers, call AvMed’s Provider Services Center at 1-800-452-8633 or email