Ophthalmology and Optometry Coding Alert

In the August issue we discussed visual field testing (92081-92083) on patients being treated with steroids for lupus or rheumatoid arthritis. We recommended V58.69 (encounter for other and unspecified procedures and aftercare; long-term [current] drug use; long-term [current] use of other medications) or V67.51 (follow-up examination; following other treatment; following completed treatment with high-risk medications, not elsewhere classified) as the diagnosis codes for these tests. We also noted that many carriers do not recognize V codes. Use of the systemic condition diagnosis, e.g., lupus (710.0) or rheumatoid arthritis (714.0), may also be rejected because it does not indicate medical necessity for visual fields.
 
A reader commented that the underlying medical necessity for a visual field may be increased intraocular pressure due to a patients adverse reaction to steroids. In such a case, billing 365.03 (borderline glaucoma [glaucoma suspect]; steroid responders) would be appropriate and would be reimbursed.