Ophthalmology and Optometry Coding Alert

Knowing how to code a resolving problem is key to getting paid for that visit and for avoiding fraud. Ophthalmologists can get reimbursed for a resolving subconjunctival hemorrhage with the correct diagnosis code.

For example, a patient calls you on a Thursday evening after extreme exertion resulted in a subconjunctival hemorrhage (372.72). You recommend that the patient make an appointment on Friday, but agree to wait until Monday when the patient explains that Friday is impossible. When the patient does appear, however, the hemorrhage is resolving. What diagnosis code can you use to code the office visit (99201-99215)?

Patricia Kennedy, COMT, associate consultant with Corcoran Consulting Group, an ophthalmology billing and coding consulting firm based in San Bernardino, Calif., says that if the hemorrhage is still there, you can use 372.72. In addition, she adds that the chart notes should not say that the hemorrhage has resolved, unless it actually has resolved. You can say resolving, if its still resolving, explains the consultant. It generally takes some time for these hemorrhages to resolve. It can take one to two weeks, unless its a pinpoint-sized hemorrhage, which might resolve in one or two days.

If a primary-care physician (PCP) refers a patient to an ophthalmologist for a subconjunctival hemorrhage, which resolves by the time the patient sees the ophthalmologist, you cannot code using 372.72, warns Kennedy. It would not be accurate because the code must match what the physician saw, she says.

But there are other codes you can use instead of 372.72, Kennedy explains. If no trace of the hemorrhage is visible to the doctor, then you can bill based on the patients complaint, which may be redness, says Kennedy. If the patient presents with some visible redness, but there are no findings to support the patients complaint of redness commensurate with subconjunctival hemorrhage, then you could use 372.71 (hyperemia of conjunctiva).

Usually, a patient is upset by the hemorrhage and comes to see the doctor right away. Even if the subconjunctival hemorrhage is partially resolved by the time the patient gets to your office, the fact is that you were evaluating the patient for a possible subconjunctival hemorrhage at the request of the primary-care provider. In that case, you can use the diagnosis code 372.72, but only if the hemorrhage is still there.