Ophthalmology and Optometry Coding Alert

If you're confused about fifth digits or V codes, read this

It's almost time to replace the outdated ICD-9 codes with the new and revised diagnosis codes, but before you take that plunge, refresh your diagnosis coding skills with three tips that make ICD-9 coding a breeze.

Tip 1: Check for a fifth-digit requirement. Ophthalmology coders who omit a required fifth digit when submitting ICD-9 codes, such as those for cataracts (366.00-366.46), can anticipate claim denials, delays and rejections.

"The purpose of the fifth digit is to allow the physician to provide greater detail, and when required it must be billed in order to facilitate reimbursement," says Susan Vogelberger, CPC, business office coordinator for a surgery center at Beeghly Medical Park in Ohio.
 
A code is invalid if it has not been coded to the highest level of specificity.

Fifth digits add additional information to the code, says Kimberly Lewis, CPC, coder for the Duke Eye Center in Durham, N.C., such as the type of diabetes a patient has.

ICD-9 code 250.5x (Diabetes with ophthalmic manifestations) has four possible fifth digits (0-3), each of which identifies a specific type of controlled or uncontrolled diabetes, Lewis says.

Best practice: If you've dealt with denials due to missing fifth digits, you should print the applicable ICD-9 codes, including the fifth digits, right on your superbill. For example, if all the cataract codes were printed on a superbill, the ophthalmologist would only have to circle the correct one, such as 366.16 (Nuclear sclerotic cataract).

If you don't have enough room on your superbill to list every last fifth digit, you should place a line after codes that require a fifth digit, says Amy Sanger, owner of Sanger Medical Management in Manhattan. For instance, the codes would be listed as 366.0__, 366.1__, and so on. "Then the person sending in the claims would be reminded to look up the appropriate digit to put on the diagnosis code."

Tip 2: When a V code is your only option, report it as the primary diagnosis. If you think that you should never report V codes (found near the back of the ICD-9 manual) as primary diagnosis codes, think again.

"Practices can use V codes for primary diagnoses under certain circumstances," Vogelberger says. Although it used to be difficult to collect reimbursement from some insurance companies when you reported only V codes, many are coming around.

Tip 3: When you have a workers' comp case, include an E code on your claim. Use E codes, such as E849.3 (Place of occurrence; industrial place and premises), to describe external causes of injuries or accidents.
 
"You should never bill E codes as your primary code, and you should list the E codes last," Vogelberger says. "It
may be necessary to assign more than one E code to fully explain each cause."