February is Low Vision Awareness Month
Age-related macular degeneration (AMD) is a progressive disease that diminishes central vision and, if left untreated, can result in severe vision loss or even blindness. AMD affects approximately 2 million Americans 50 years and older and is the leading cause of blindness in the United States in patients 65 and older. Prevent Blindness America—a volunteer health and safety organization—declared February as Low Vision Awareness Month to increase awareness of this incurable disease.
The part of the eye affected by AMD is the macula—the sensitive part of the retina responsible for sharp, central vision. Vision loss is gradual and often goes undetected until it is too late. If detected early, however, the progression of this disease can be delayed or possibly prevented.
According to Prevent Blindness America, early warning signs include:
Straight lines, such as a flag pole or streetlight, may appear wavy
A dark or empty spot may block the center of vision
- Written words or type may appear blurry
According to the National Eye Institute, risk factors for AMD include:
Smoking: Smoking and even second-hand smoke may increase the risk of AMD.
Obesity: Research studies suggest a link between obesity and the progression of early stage AMD to advanced AMD.
Race: Caucasians are much more likely to lose vision from AMD than African Americans.
Gender: Of the more than 2 million Americans age 50 and older that have AMD, more than 1.3 million of those cases are women.
Family History: Those who have immediate family members with AMD are at a higher risk of developing the disease.
Diagnosis of AMD is made after a comprehensive eye exam. Screening tests usually include the Amsler grid and a dilated retinal exam (2022F Dilated retinal exam with interpretation by an ophthalmologist or optometrist documented and reviewed (DM)). If AMD is suspected, a dye-injection test (CPT® 92240 Indocyanine-green angiography (includes multiframe imaging) with interpretation and report) may be ordered.
Diagnostic coding depends on documentation. You might start out with 362.5 Other retinal disorders; degeneration of macula and posterior pole. If the physician documents a family history of AMD, however, you should instead report 362.7 Other retinal disorders; hereditary retinal distrophies. If documentation mentions the type of AMD, a fifth digit could be added to either subcategory (eg, 362.51 Other retinal disorders; nonexudative senile macular degeneration of retina, dry or 362.52 Other retinal disorders; exudative senile macular degeneration of retina, wet).
Treatment depends on the type of AMD—dry (non-neovascular) or wet (neovascular). For dry AMD, which is an early stage, treatment focuses on delaying or lessening progression of the disease. Studies show vitamins C and E as well as beta-carotene and zinc delay progression. For wet AMD (there are two types: occult and classic), procedures such as photocoagulation and macular translocation provide variable results. Anti-vascular endothelia growth factor (anti-VEGF) injectible medications are also an option.
ICD-9-CM procedure code 13.91 Operations on lens; implantation of intraocular telescope prosthesis can be used to identify the implantation of the intraocular telescope prosthesis, including the removal of any lens, any method. Use code 16.61 Operations on orbit and eyeball; Secondary procedures after removal of eyeball, secondary insertion on ocular implant to report a secondary insertion of the ocular implant.
There are no Category I codes to represent the insertion of an intraocular implant without treatment of cataract. Optionally, if documentation supports, you might report Category III codes 0100T Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy or the revised 0124T Conjunctival incision with posterior extrascleral placement of pharmacological agent (does not include supply of medication). When reporting 0124T, remember to also report a HCPCS Level II code for the medication.
For the neovascularization forms of AMD, you have Category III code 0017T Destruction of macular drusen, photocoagulation, as per the instructional note under CPT® code 67220 Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), one or more sessions. Finally, for photodynamic therapy, you have CPT® 67221 Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion).