Focus on Coding 3 Common Pediatric Eye Conditions
ICD-10-CM coding is clear when you know what to look for.
Children’s Eye Health and Safety Month is a good time to brush up on your coding for eye-related diagnoses pediatric providers see in their patients. We’ll get you started by reviewing three diagnoses your providers probably see most often during an eye and vision exam.
Watch for Abnormal Findings With Vision Screenings
Children commonly undergo basic vision screenings, often to meet school requirements. For these vision screenings, you’ll turn to the following Z codes in ICD-10-CM:
Z01.00 Encounter for examination of eyes and vision without abnormal findings
Z01.01 Encounter for examination of eyes and vision with abnormal findings
Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings
Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
Effective Oct. 1, 2019, ICD-10-CM introduced three new codes under Z01.0 Encounter for examination of eyes and vision, which differ from the previously existing Z01.00 and Z01.01 codes.
Now, you can document an exam performed as a follow-up to a failed vision screening without abnormal findings (Z01.020) and with abnormal findings (Z01.021). Note that the new six-digit codes state that the encounter was specifically for visits following failed vision screenings, with or without abnormal findings. The codes help justify the need for further vision or hearing testing, which could be very important, especially if a vision or hearing test was performed that same year in a well-care visit.
This change brought the vision codes in line with the Z01.1x Encounter for examination of ears and hearing codes. And like the other vision codes, Z01.021 includes a note telling you to use an additional code to specify what the abnormal findings are.
Scenario: A pediatric patient presents to your eye care practice after failing a school vision screening. The optometrist notes no issues with the patient’s vision and determines that the patient has excellent eye health, with no abnormalities.
Coding: Report Z01.020. This six-character code tells the payer that the provider saw the patient as a follow-up to a prior failed vision screening and justifies a second screening.
Distinguish Viral, Non-viral Conjunctivitis
Conjunctivitis (pink eye) is a common eye-related illness in children, especially when they are in close proximity at schools, camps, and activities. The tricky part to assigning a diagnosis is that there are many types of conjunctivitis. You’ll need to scour your provider’s documentation for specific details to ensure you assign the correct diagnosis code.
Conjunctivitis is characterized by redness and inflammation of the transparent membrane (conjunctiva) that covers the front surface of the eyeball and lines the inner part of the eyelids. Not every case is identical, however — even if the conjunctivitis comes from the same source.
The most common causes of conjunctivitis are viruses, bacteria, and allergens. Some forms are found among the infectious and parasitic diseases in Chapter 1 of ICD-10-CM, while others are found among the diseases of the eye in Chapter 7. There’s even one form of bacterial conjunctivitis caused by the gonococcus bacterium, which affects neonates, classified as P39.1 Neonatal conjunctivitis and dacryocystitis.
The codes from category B30, such as the ones listed below, describe the conjunctival inflammation associated with viral infections:
B30.0 Keratoconjunctivitis due to adenovirus [Shipyard eye]
B30.1 Conjunctivitis due to adenovirus [Swimming-pool conjunctivitis]
B30.2 Viral pharyngoconjunctivitis
B30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral)
B30.8 Other viral conjunctivitis [Newcastle conjunctivitis]
Both B30.0 and B30.1, for example, are caused by adenoviruses, described by the Centers for Disease Control and Prevention (CDC) as a common cause of respiratory illness, that can result in “cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhea, and pink eye (conjunctivitis).”
The H codes, such as the following, describe bacterial and allergic conjunctivitis, as well as unspecified conjunctivitis:
H10.01 Acute follicular conjunctivitis
H10.1 Acute atopic conjunctivitis [Acute papillary conjunctivitis]
H10.41 Chronic giant papillary conjunctivitis
H10.43 Chronic follicular conjunctivitis
Within the H code category, you’ll need to know whether the patient has acute or chronic conjunctivitis, as well as whether they have follicular or papillary. To choose the proper code, follow these steps:
1. First, ask: “Is the condition acute or chronic?” Conjunctivitis can come on and resolve quickly or it can persist for several weeks. Your pediatrician must note “acute” or “chronic” for you to code with specificity. Query the provider if necessary.
2. Second, ask: “Is it follicular or papillary?” Follicular conjunctivitis is often caused by a virus, bacteria, or a medication reaction and is characterized by small, dome-shaped nodules in the eye. Papillary is often due to an allergic immune response or a foreign body and is characterized by papillae on the eyelid surface. For proper code selection, your provider needs to document either “nodules” or “papillae.” Query the provider if necessary.
3. Finally, ask: “What part of the eye is affected?” Once you know whether the condition is acute or chronic and follicular or papillary, locate the affected eye. The H10 codes take a fifth or sixth character to note whether the condition is occurring in the right eye (1), the left eye (2), bilaterally (3), or whether the eye is unspecified (9). For instance, acute follicular conjunctivitis of the right eye would be coded with H10.011 Acute follicular conjunctivitis, right eye.
Other types of conjunctivitis include mucopurulent (H10.02x), atopic (H10.1x), toxic (H10.21x), pseudomembranous (H10.22x), and serous (H10.23x), among others. If you see notation of these types of conjunctivitis, report the appropriate code and not one from the unspecified series.
Ultimately, the key to successful conjunctivitis diagnosis coding is documentation. Because conjunctivitis is often a self-limited problem that requires little treatment or diagnostic testing, providers may not include much documentation. Ensure your providers seeing these conditions are documenting enough specifics to lead you to the correct ICD-10-CM codes.
Review ‘S’ Codes for Corneal Abrasions
Children are active and at high risk for being poked in the eye or getting a foreign body in their eye, both of which can lead to a corneal abrasion.
To report a corneal abrasion, you’ll flip to the “S” section (Injury, Poisoning, and Certain Other Consequences of External Causes) of ICD-10-CM. In this section, you will base your code selection on the anatomical location (which eye) and the encounter (initial, subsequent, sequela), as shown here:
S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounter
S05.00XD Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, subsequent encounter
S05.00XS Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, sequela
S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter
S05.01XD Injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter
S05.01XS Injury of conjunctiva and corneal abrasion without foreign body, right eye, sequela
S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter
S05.02XD Injury of conjunctiva and corneal abrasion without foreign body, left eye, subsequent encounter
S05.02XS Injury of conjunctiva and corneal abrasion without foreign body, left eye, sequela
Scenario: A 13-year-old new patient comes in to see your ophthalmologist with pain, redness, and tearing in her right eye. She mowed the lawn earlier that day and thought she was just suffering from allergies, but later in the day she noticed that her vision was blurred and she developed a headache. On examination, the physician diagnosed a corneal abrasion in the right eye.
Coding: S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter.
Be sure to read the accompanying article, “Ensure Good Vision Through Life,” to gain awareness of pediatric eye health and safety.
Torrey Kim has been writing about medical coding, billing, and compliance for over 15 years. She has covered in-depth topics for Advance and The Coding Institute’s Optometry/Ophthalmology Coding Alert and ED Coding Alert.
Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS, AAPC MACRA Proficient, head of publishing, editorial and technology at AAPC, specializes in medical coding and reimbursement for evaluation and management, urology, and general surgery, as well as billing and collections policies and strategies for physician practices. Israel is a member of the Rochester, N.Y., local chapter.
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