Identify Inflammatory Sclera Conditions for Your Claim
Don’t forget to specify laterality with a 6th character. The eye is made up of several structures, including, but not limited to, the retina, sclera, macula, iris, pupil, cornea, and lens. When one of those parts is injured, the patient may experience vision difficulties. One condition that can lead to pain, redness, and even loss of vision is scleritis. Read on to familiarize yourself with scleritis in its different forms and how to code each condition. What Is Scleritis? The sclera makes up most of the connective tissue at the back of the ocular globe. It helps maintain the eye’s shape and provides attachment points for extraocular muscles. Multiple blood vessels and nerves pass through the scleral foramen. Scleritis occurs when the sclera becomes inflamed. As a result, the sclera, which is normally white, becomes red. Patients experiencing the condition may present with swelling, tenderness, pain, tearing, and light sensitivity in the eye. Idiopathic scleritis is when the condition occurs without a known cause. On the other hand, many patients develop scleritis as a complication from another medical condition. Other conditions that can cause scleritis include: Turn to the Alphabetic Index in the ICD-10-CM code book to locate “Scleritis.” You’ll then verify the code in the Tabular List under the H15.0- (Scleritis) code category. Next, we’ll break down the code subcategories for each of the different types of scleritis. Remember the 6th Character for Scleritis Laterality Each scleritis code requires a 6th character to specify laterality. Simplify your code recall with this helpful list, as all of the following 6th characters apply to every scleritis diagnosis code: Only use 4 as a 6th character when the physician’s documentation does not contain any mention of which eye or eyes are affected. Get to Know Anterior and Posterior Scleritis The two main types of scleritis occur at the front or the back of the eye. Anterior scleritis, coded with the H15.01- (Anterior scleritis) subcategory, develops at the front of the eye. Patients may experience pain when moving their eye, watery eyes, and sensitivity to light. According to the National Institutes of Health, anterior scleritis occurs in 98 percent of cases. Anterior scleritis can be further broken down into three specific types: Posterior scleritis, reported with codes in the H15.03- (Posterior scleritis) subcategory, occurs when the scleritis develops at the back of the eye. Posterior scleritis develops in 2 percent of cases. Providers can view retinal detachment, swelling in the optic nerve, and cotton wool spots during dilated examinations. Posterior scleritis includes diffuse and nodular scleritis, but the types can be difficult to diagnose because the conditions occur at the back of the eye, and the eye may still appear white. Pick Up Brawny Scleritis Knowledge Brawny scleritis is a specific type of scleritis that is characterized by hard, nontender swelling of the sclera. The swelling can be accompanied by redness. While the patient may experience pain, light sensitivity, and redness with regular scleritis, brawny scleritis symptoms tend to be more intense. The condition gets its name from the tough, leathery feel of the inflamed sclera. If an ophthalmologist diagnoses the patient with brawny scleritis, you’ll use a code from the H15.02- (Brawny scleritis) subcategory. Recognize What ‘Corneal Involvement’ Means You’ll assign an appropriate H15.04- (Scleritis with corneal involvement) code when the provider documents that the inflammation of the sclera has spread to the cornea and both structures are affected. In addition to the common scleritis symptoms, the inflammation can cause the development of corneal ulcers, scarring, and corneal perforation. The ICD-10-CM Official Guidelines direct you to specify the diagnosis as best you can with the documentation provided and the codes available. If the documentation is unclear as to whether the inflammation has spread to the cornea, you can always query the provider for clarification on the documented diagnosis. Watch Out for Scleromalacia Perforans Diagnoses As mentioned above, you’ll assign an appropriate anterior or posterior code when necrotizing scleritis occurs with inflammation; but if the necrotizing scleritis develops without inflammation, then you’ll assign H15.05- (Scleromalacia perforans) to report the condition. Necrotizing scleritis without inflammation is also known as scleromalacia perforans. The condition causes severe thinning of the sclera and the patient’s choroid may be visible. It is the most severe form of anterior scleritis, but it is rare. The condition is a form of anterior scleritis, but you will use an H15.05- code to report the diagnosis since the subcategory offers greater specificity of the diagnosis than H15.01-. Learn When to Use Other or Unspecified Scleritis Codes The last two code subcategories in the scleritis family are H15.00- (Unspecified scleritis) and H15.09- (Other scleritis). You’ll assign an unspecified scleritis code when the physician doesn’t specify the type of scleritis in the documentation, whereas H15.09- codes will be assigned when the documented diagnosis cannot be reported with other scleritis codes in the code book. For example, a scleral abscess would fall under the H15.09- code subcategory. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
