Ophthalmology and Optometry Coding Alert

From focal laser to PRP, diagnosis codes and bilateral rules, there are a lot of variables to keep track of.

According to the Centers for Disease Control, 4.1 million Americans suffer from diabetic retinopathy, and 899,900 suffer from vision-threatening retinopathy. It is the leading cause of new cases of blindness in working-age adults. Early detection and proper treatment are critical to your patients — and proper coding is critical to your practice.

Answer these DR coding questions, then read on to see how you did compared with our experts.

Question 1: Which ICD-9 code would you report as the primary diagnosis for a patient with proliferative diabetic retinopathy as a result of uncontrolled type II diabetes?

A. 250.50
B. 250.52
C. 362.01
D. 362.02

Question 2: For a severe case of background diabetic retinopathy, the ophthalmologist uses a focal laser to treat areas of edema resulting from leaking blood vessels. What CPT® code would you report?

A. 67210
B. 67218
C. 67220
D. 67228

Question 3: The ophthalmologist uses pan-retinal photocoagulation to treat DR in both eyes. You would report:

A. one unit of 67210
B. two units of 67210
C. one unit of 67228
D. two units of 67228

Question 4: On Sept. 15, the ophthalmologist performs focal laser surgery on the area of edema in the left eye. On Oct. 15, the patient returns for a postoperative visit, and the ophthalmologist performs another focal laser treatment for an area of edema that has appeared in the same eye. For the Oct. 15 procedure, you would report:

A. 67210-LT
B. 67210-59-LT
C. 67210-79-LT
D. You would not bill for this procedure.