Ophthalmology and Optometry Coding Alert

Save your practice from denials by accurately coding nonspecific complaints.

When a patient presents with vague, generalized complaints — such as blurry vision, dry eyes, or a foreign-body sensation — you can find the right code to report if you check a few simple criteria.

Check out these scenarios connected to nonspecific diagnoses, and follow the clues to find the right ICD-10 code.

Make Clear Choices for Blurred Vision

Some coders say that when patients present with blurred vision, they turn to H53.8 (Other visual disturbances). Many insurance carriers don’t agree, however, using the logic that there must be something causing the “disturbance,” and insisting you report the cause, not the symptom.

Coder’s Rule: If a patient has a medical problem, use the final diagnosis; if the patient has only blurred vision, use H53.8. Example: A patient presents with a complaint of blurry vision, and the ophthalmologist finds a cataract. Report cataract (such as a code from the H25 series) as the primary diagnosis.

If the patient doesn’t specifically complain of blurred vision, but instead asks for a routine eye exam, it gets a little trickier. How you code may depend on the insurance, according to experts. If the patient is coming in for a routine vision exam and you know you’re going to bill vision insurance, report it with an eye encounter code, such as Z01.00 (Encounter for examination of eyes and vision without abnormal findings).

Get to Know Dry Eye Codes

“Dry-eye syndrome” is usually caused by problems with the lacrimal gland (tears). The most common diagnosis code associated with dry eye is H04.12 (Dry eye syndrome). Another diagnosis you might see is H16.229 (Keratoconjunctivitis sicca, not specified as Sjogren’s, unspecified eye).

Warning: Some coders believe they can use H04.12 and H16.149 (Punctate keratitis, unspecified eye) interchangeably, but this is not true. If a patient presents with punctate keratitis and the ophthalmologist determines that dry-eye syndrome is the cause, report H04.12. If the patient’s dry eyes are caused by punctate keratitis, you’ll instead report H16.149.

Don’t Be a Stranger to Foreign-Body Codes

A patient who presents with a foreign-body sensation (i.e., the feeling that there’s something in their eye) causes no coding problems — as long as there actually is something in their eye. The T15 series (Foreign body on external eye) covers foreign bodies on the external eye; look at codes such as S05.40XA (Penetrating wound of orbit with or without foreign body, unspecified eye, initial encounter) or S05.50XA (Penetrating wound with foreign body of unspecified eyeball, initial encounter) for penetrating wounds.

If the ophthalmologist removes FBs from different anatomical parts of the same eye, however, then you can report a pair of codes, say experts.

Example: The ophthalmologist removes a superficial conjunctival FB and a corneal FB from a patient’s eye; evidence of slit lamp use is in the notes. On the claim, you would report the following:

• 65222 (Removal of foreign body, external eye; corneal, with slit lamp) for the slit lamp removal with T15.00XA (Foreign body in cornea, unspecified eye, initial encounter) appended to represent the FB
• 65205 (Removal of foreign body, external eye; conjunctival superficial) for the conjunctival removal with T15.10XA (Foreign body in conjunctival sac, unspecified eye, initial encounter) appended to represent the FB.

What if the patient complains of a foreign-body sensation, but the ophthalmologist’s exam finds no sign of a foreign body or penetrating substance? Code the complaint — pain in and around the eye — experts say.

Key: If it is a foreign-body complaint, chances are the patient is in some kind of pain, and if the pain cannot be attributed to something specific, you have the option of using an unspecified eye-pain code, such as H57.13 (Ocular pain, bilateral) or a code representing a specific result of the pain. For example, if the foreign-body sensation resulted in inflammation, you can use S05.00XA (Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounter) for corneal abrasion or S05.00XA (Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounter) for conjunctival abrasion.

Another possible cause for a foreign-body sensation is dry-eye syndrome. If the patient has dry-eye syndrome, you should report that code.