Optometry Coding & Billing Alert
READER QUESTION ~ Current Condition Should Drive Your Diagnosis Coding
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Question: How should I bill BCBS for a routine exam with the diagnosis being post-keratoplasty OD and keratoconus? What would the correct diagnosis codes be? Answer: The appropriate diagnosis should reflect the current condition of the eye, not the history or risk factors. The right eye would most likely qualify as 743.41 (Anomalies of corneal size and shape). The left eye would be 371.60 to 371.62 (Keratoconus).
Tennessee Subscriber
If the transplant on the right eye has worked well and the eye is 20/20, it could be hard to make a case for an anomaly of size and shape -- but as long as the left eye is kerataconic, the condition of the OD is immaterial. You only need one diagnosis for an exam.
However, if these are indeed the diagnoses, this is not a routine exam, even if you are billing eye codes.
Optometry Coding & Billing Alert
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