ED Coding and Reimbursement Alert

Question: A patient presents with eye irritation and discharge. After a level-three ED evaluation and management (E/M) service, the provider diagnoses “mucopur. conjunctivitis.” I have found the heading for H10.0- (Mucopurulent conjunctivitis), but I am having trouble zeroing in on the proper ICD-10 code. How do I go from H10.0- to a more specific diagnosis for this patient?

Tennessee Subscriber

Answer: You’ll have to do some digging into the notes — or speak with the provider — before you can land on the exact diagnosis you’ll need for your 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity...) claim.

The diagnosis codes for H10.0- are broken into two categories: H10.01- (Acute follicular conjunctivitis) and H10.02- (Other mucopurulent conjunctivitis). According to the American Academy of Family Physicians (AAFP), “acute bacterial conjunctivitis typically presents with burning, irritation, tearing and, usually, a mucopurulent or purulent discharge. Patients with this condition often report that their eyelids are matted together on awakening. Conjunctival swelling and mild eyelid edema may be noted.”

On the other hand, follicular conjunctivitis is the least severe form of a viral conjunctival infection. Its onset is acute and usually begins in one eye, with the other eye often becoming infected within the week after initial onset. Symptoms include a watery discharge, conjunctival redness, follicular reaction, and a preauricular lymphadenopathy on the affected side.

Acute follicular conjunctivitis: If the final diagnosis is acute follicular conjunctivitis, choose from the following codes, depending on encounter specifics:

• H10.011 (Acute follicular conjunctivitis, right eye)
• H10.012 (… left eye)
• H10.013 (… bilateral)
• H10.019 (… unspecified eye)

Mucopurulent conjunctivitis: If the final diagnosis is any other form of mucopurulent conjunctivitis, choose from the following codes, depending on encounter specifics:

• H10.021 (Other mucopurulent conjunctivitis, right eye)
• H10.022 (… left eye)
• H10.023 (… bilateral)
• H10.029 (… unspecified eye)

Symptoms: Look for mention of the following symptoms before assigning the ICD-10 code for mucopurulent conjunctivas:

• Red eye(s)
• Discharge: Classically purulent, but may be thin or thick muco-purulent
• Irritation, burning, stinging, discomfort
• Tearing
• Light sensitivity
• Intolerance to contact lens
• Fluctuating or decreased vision.