Optometry Coding & Billing Alert

Published on Fri Jun 04, 2010 PDF

Question: We keep getting denials for 92082 and 92083 (Visual field examination ...) linked to the diagnosis code 365. What can we do to get paid?

Delaware Subscriber

Answer: If you're using 365 as a diagnosis code, your visual fields claims are getting denied because the code isn't specific enough. The 365 series (Glaucoma) includes codes carried out to the fifth digit to describe the glaucoma as specifically as possible, such as 365.02 (Borderline glaucoma [glaucoma suspect]; anatomical narrow angle) and 365.21 (Intermittent angle-closure glaucoma). Whenever fourth or fifth digits are available for an ICD-9 code, insurers look for them on claims; if they don't find them, they will probably reject the claim.

Tip: In the ICD-9 manual, look beside the code for a checkmark icon. That warns you that you need at least one more digit for the code to be considered complete.