Ophthalmology and Optometry Coding Alert

Question: How can I find an acceptable diagnosis code for 76514 (Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) for a Medicare patient?

New Mexico Subscriber

Answer: The best way to find an acceptable diagnosis code for any service, including an ophthalmic ultrasound, is to look at the documentation. Although it’s tempting to search Local Coverage Determinations (LCDs) for a payable diagnosis code for any particular procedure, that’s not correct coding. Instead, you should determine the reason as to why the procedure was performed from the provider’s documentation and report those.

If you are new at coding diagnoses from the physician’s notes, you should double-check your code selections with the practitioner before submitting your claims. Until a coder feels comfortable with the ICD-10 books and the codes used more often in their offices, it’s a good idea to run the choices by a clinician. You never want to give a patient a disease or symptom they don’t have or one more severe (or less) than what they have. This is also beneficial to the physicians, because it may prompt them to learn how to better document the patient’s condition into their notes.

Tip: Make sure your office creates a policy in writing that spells out what you should do when you encounter a superbill with no diagnosis listed. Some physicians prefer that you ask them for information, while most others rely on their coders to select an accurate code.