Optometry Coding & Billing Alert

Published on Wed Aug 19, 2015 PDF

Question: How should I bill for a routine exam with the diagnosis post-keratoplasty in the right eye, and keratoconus in the left eye? What would the correct diagnosis codes be?

Alabama Subscriber

Answer: Before Oct. 1, 2015, report ICD-9 code 371.60 (Keratoconus, unspecified), 371.61 (Keratoconus, stable condition) or 371.62 (Keratoconus, acute hydrops) for the keratoconic left eye. To show the post-keratoplasty status in the right eye, report V42.5 (Organ or tissue replaced by transplant; cornea).

Keep in mind, however, that some insurers balk at reimbursing for V-codes. Policies vary depending on which specific carrier you’re billing. If the carrier denies your claim with V42.5, you can try reporting 367.22 (Irregular astigmatism) instead.

ICD-10: After ICD-10 takes effect on Oct. 1, 2015, your coding will change. Report one of the following:

• H18.601 – Keratoconus, unspecified, right eye

• H18.602 – ... left eye

• H18.603 – ... bilateral

• H18.609 – ... unspecified eye

• H18.611 – ...stable, right eye

• H18.612 – ... left eye

• H18.613 – ... bilateral

• H18.619 – ... unspecified eye

• H18.621 – ...unstable, right eye

• H18.622 – ... left eye

• H18.623 – ... bilateral

• H18.629 – ... unspecified eye.

Instead of ICD-9 code V42.5, you would report ICD-10 code Z94.7 (Corneal transplant status).

• Note: If you’re fitting a keratoconus patient for contact lenses, stay away from 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia). Use that code only when prescribing contacts to correct a refractive error. For keratoconus lenses, report 92072 (Fitting of contact lens for management of keratoconus, initial fitting).