Early May eClaim Enhancements: CPT Category II Codes and Patient Conditions

Eye Exam for Patients with Diabetes Reporting Message

Starting in early May, a message will appear in eClaim on eyefinity.com, to remind you to include the appropriate Current Procedural Terminology (CPT) Category II code, when you check the patient condition box or enter the diagnosis code for diabetes or diabetic retinopathy when submitting a claim.  

Click Resolve on the reminder message to be taken to the location on the form where you can manually enter the appropriate CPT Category II code or select the appropriate code from the CPT/HCPCS pop-up box. 

Including the CPT Category II codes on the claim provides the quality-of-care information needed by VSP^® health plan clients to meet the Healthcare Effectiveness Data and Information Set (HEDIS)—Eye Exam for Patients With Diabetes performance measure, and the Centers for Medicare and Medicaid Services (CMS) Star Rating program requirements. This benefits your practice by:

• Eliminating the administrative burden of pulling chart notes for requested patients
• Supporting you in meeting Medicare’s Merit-based Incentive Payment System requirements
• Elevating the role of optometrists in the management of systemic conditions
• Emphasizing the importance of annual eye exams

Additional resources, including a downloadable reference sheet of Eye Exam for Patients with Diabetes Reporting using CPT Category II codes, are available at vspeyeondiabetes.com.

Patient Condition Check Boxes

Also starting in early May, new patient condition check boxes for glaucoma and age-related macular degeneration will appear in the Known Conditions area in the Services section of the eClaim form on eyefinity.com. The check boxes will be reorganized by ocular and systemic conditions for easier reference. 

Including the glaucoma and age-related macular degeneration patient condition check boxes provides additional information that may lead to better care for your VSP patients, further elevating the role Doctors of Optometry have in a patient’s overall health. 

Questions? Please email providernetworkdevelopment@vsp.com.