Ophthalmology and Optometry Coding Alert

Hint: Evaluate laterality carefully when picking a diagnosis.

Eye care practices have been using the new CPT^® and ICD-10 codes for a while now, and Ophthalmology Coding Alert has received several questions on the best ways to incorporate them into your practice. To get you up to speed on the 2019 codes, check out the answers to the three most frequently-asked questions.

1. We heard that the blepharitis codes were overhauled this year – how should we now report ulcerative blepharitis of the left upper eyelid?

As most eye care coders are aware, new codes in the 2019 edition of ICD-10 expanded the blepharitis codes to allow you a way to report additional eyelids, when affected. However, that doesn’t mean you will find new codes for every blepharitis condition.

When the patient has ulcerative blepharitis of the left upper eyelid, you’ll report H01.014 (Ulcerative blepharitis, left upper eyelid). This is the same way you reported it in 2018.

Here’s what changed: What’s new for 2019 is that the ICD-10 manual allows you to report just one code when more than one eyelid is affected with blepharitis, rather than the old way, which requires you to bill multiple codes when you treat multiple eyelids. The new 2019 codes are as follows:

• H01.00A —  Unspecified blepharitis right eye, upper and lower eyelids
• H01.00B — Unspecified blepharitis left eye, upper and lower eyelids
• H01.01A — Ulcerative blepharitis right eye, upper and lower eyelids
• H01.01B — Ulcerative blepharitis left eye, upper and lower eyelids
• H01.02A — Squamous blepharitis right eye, upper and lower eyelids
• H01.02B — Squamous blepharitis left eye, upper and lower eyelids

Therefore, you should code blepharitis using the “business as usual” approach unless multiple eyelids are affected.

2. Which of the two new ERG codes apply to pattern ERG? Is it 92273 or 92274?

Neither of these CPT® codes represents the correct way to report pattern ERG, unfortunately. The reality is that CPT^® introduced not two – but three – new codes for 2019, but one of them is a Category III code, so you may not be aware of it. Following are the three new ERG codes that went into effect on Jan. 1, 2019:

• 92273 —  Electroretinography (ERG), with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG)
• 92274 — Electroretinography (ERG), with interpretation and report; multifocal (mfERG)
• 0509T -- Electroretinography (ERG) with interpretation and report, pattern (PERG)

Here’s the difference: In your case, the right code would be 0509T because your physician performed a pattern ERG. Keep in mind that the introductory note to the section of CPT® where these codes are listed states “Multiple additional terms and techniques are used to describe various types of ERG. If the technique used is not specifically named in the code descriptors for 92273, 92274, or 0509T, use the unlisted procedure code 92499.”

Therefore, not all of your ERG services will always fit into one of the three above codes. In some situations, 92499 will instead be your best bet. This shows why it’s so important to read the documentation carefully to confirm the ERG type before selecting the right code.

3. When can we report the unlisted melanoma code C43.10?

Only when you absolutely have no other options.

Since Oct. 1, you’ve had several new codes to choose from in the malignant melanoma of eyelid category, now requiring you to have very specific information about the location of the eyelid lesion.

You’ll see there are codes for the right side, left side, upper eyelid, and lower eyelid. In addition, there are codes that describe the “unspecified” eyelid, but you should try to avoid using the unspecified code C43.10 (Malignant melanoma of unspecified eyelid, including canthus). Payers want to know that you are documenting well enough to select the site-specific codes whenever possible.

So if a patient has a malignant melanoma of the eyelid, including canthus, your options now include:

• C43.111 — Malignant melanoma of right upper eyelid, including canthus
• C43.112 — Malignant melanoma of right lower eyelid, including canthus
• C43.121 — Malignant melanoma of left upper eyelid, including canthus
• C43.122 — Malignant melanoma of left lower eyelid, including canthus

Therefore, scrutinize every medical record to pinpoint the site and laterality before you can select the most appropriate code.