Chief complaint determines whether or not the eye examination is routine or medical in nature. CMS is very clear on this: The Medicare Carriers Manual, Part 3 §2320 reads: “The coverage of services rendered by a physician is dependent on the purpose of the examination rather than on the ultimate diagnosis of the patient’s condition.
Full Answer
What is a chief complaint in a medical exam?
Chief Complaint The chief complaint is the focus of the exam. If the patient has several complaints, document them in order of highest to lowest medical risk.
Does Medicare cover routine eye exams?
Since routine eye exams are generally not covered by Medicare, you’d pay 100 percent of their cost. If you’re at risk for glaucoma or diabetes, Medicare Part B can cover annual eye exams once every 12 months. For instance, if you use Medicare Part B for glaucoma eye exams, 80 percent of the exam will be covered.
Can a treating/billing provider verify a patient’s chief complaint?
The treating/billing provider should personally verify the patient’s chief complaint. For example, a patient may be embarrassed, or have other reasons not to share the “real” CC with ancillary staff, or to record it on a patient questionnaire or intake form.
What happens if the patient record does not reflect a chief complaint?
If the patient record does not reflect a chief complaint, the service is either: Unbillable. The treating/billing provider should personally verify the patient’s chief complaint.
What is a chief complaint in Optometry?
The patient history begins with the chief complaint. It should detail the primary reason(s) the patient scheduled the examination. Ideally, it should be recorded in the patient's own words. The chief complaint also suggests what tests you'll need to perform and the possible CPT code to use for the encounter.
What is chief complaint example?
A chief complaint is a statement, typically in the patient's own words: “my knee hurts,” for example, or “I have chest pain.” On occasion, the reason for the visit is follow-up, but if the record only states “patient here for follow-up,” this is an incomplete chief complaint, and the auditor may not even continue with ...
What is your chief complaint?
What is the Chief Complaint (CC)? The CC is a brief statement that describes the symptom, problem, diagnosis, or other reason for the patient encounter. The CC is usually stated in the patient's own words: “I have an upset stomach, my knees ache, and I need refills on my pain pills.”
How do I file a chief complaint in ophthalmology?
A chief complaint is a quick summary of why the patient is there. It should include only the most pertinent information about the patient's reason for the visit.
What is a chief complaint in medical?
INTRODUCTION. A chief complaint is a concise statement in English or other natural language of the symptoms that caused a patient to seek medical care. A triage nurse or registration clerk records a patient's chief complaint at the very beginning of the medical care process (Figure 23.1 ).
How should the patient's chief complaint be documented in terms of?
Chief Complaint (CC): A concise statement describing the reason for the encounter. The CC should be clearly reflected in the medical record for each encounter and is usually stated in the patient's words.
What is the most common chief complaint?
Sore throat, skin rash, abdominal pain, earache, and backache were the five most common complaints (302 per 1,000 patients.) These complaints and 19 other problems were responsible for 822 patient visits per 1,000 in a study of 2,272 consecutive new patient visits.
What is chief complaint abbreviation?
• CC Chief Complaint of Patient.
Is chief complaint required?
A chief complaint (CC) is a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return or other factor that is the reason for the patient encounter. A CC is required for all levels of service.
How do you file a chief complaint?
A chief complaint should comprise a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return or other factors that establish the reason for the encounter in the patient's own words (e.g., aching joints, rheumatoid arthritis, gout, fatigue, etc.).
What questions should I ask a chief complaint?
The pain may be acute or chronic. It may be located in the abdomen, chest, head or any other body part....The “Magnificent Seven”Location: Where is the pain now? ... Onset: How did the pain start? ... Duration: How long has the pain been present? ... Severity: How bad is the pain now? ... Quality: What type of pain is it?More items...
What are the major complaints of a patient with eye disease?
These are the warning symptoms and history you should watch for when working up any eye patient:Acute loss of vision (either a partial visual field, or an entire eye)Sudden increase in flashers or floaters, curtain or shadow.Eye pain.Marked redness of eye.Reduced visual acuity.Photophobia.More items...•
Which eye exams does Medicare pay for?
In general, Medicare doesn’t cover routine eye exams for eyeglasses or contact lenses. However, there are exceptions to this rule.
How often does Medicare pay for eye tests?
Medicare does pay for routine eye tests, but only if they’re deemed medically necessary. For example, if you have diabetes and are at high risk for...
Is an eye checkup covered by Medicare?
Although routine eye checkups or vision care are not covered by Medicare, there are exceptions to this rule such as medically necessary services li...
Does Medicare Part B cover ophthalmologists?
Medicare Part B can pay for corrective lenses, one pair of eyeglasses, or a set of contact lenses that are provided by an ophthalmologist.
Does Walmart accept Medicare for eyeglasses?
Yes, if you have Medicare and have undergone cataract surgery within the last year, then Medicare can help cover the cost of eyeglasses at Walmart.