Ophthalmology and Optometry Coding Alert

Condition Spotlight:

Learn Which Details Lend To Correct Coding of Hypotony Cases

Published on Wed Mar 20, 2024

Cause of condition may ease your code selection woes.

Ophthalmologists are no strangers to hypotony, so understanding the nuances involved in properly coding this common ocular condition is crucial if you want to avoid losing time and money. Knowing when to just submit codes for symptoms, which testing codes can be reported with an ophthalmological service code, and what details drive hypotony diagnosis code selection is a lot to keep straight in order to achieve claim success.

That’s why we put together this handy primer packed full of pro tips on code options and proper coding practices. Keep reading to ensure your coding of this sight-threatening condition is spot on.

Use These Codes Until a Dx Is Confirmed

The symptoms in a patient with suspected ocular hypotony — intraocular pressure (IOP) low enough to cause clinically significant complications — may vary depending on the severity of the condition. When scouring the initial chart note, keep an eye out for mention of the following:

Blurred vision: H53.8 (Other visual disturbances)
Visual impairment: H54.7 (Unspecified visual loss)
Severe throbbing eye pain: H57.1- (Ocular pain)
Photophobia: H53.14 (Visual discomfort)
Headache: R51.9 (Headache, unspecified)

Make sure to report codes for the patient’s symptoms until the physician has established a definitive diagnosis.

Be Wise in the Ways of Reporting the Workup

When a patient presents with possible ocular hypotony, the ophthalmologist will typically conduct a comprehensive eye examination, coded with 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits) or 92014 (… comprehensive, established patient, 1 or more visits) depending on whether the patient is new or established.

Be aware of this bundle: Hypotony often causes visual problems that can be detected through visual acuity testing such as 99173 (Screening test of visual acuity, quantitative, bilateral). However, you should not report 92004/92014 in conjunction with 99173, as the screening is bundled into the ophthalmological services code.

Your eye care provider may perform other tests, such as the following, to confirm a diagnosis of hypotony:

Measurement of IOP: 92100 (Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day …)
Fundus Examination: 92250 (Fundus photography with interpretation and report)
Ultrasound Biomicroscopy: 76513 (Ophthalmic ultrasound, diagnostic; anterior segment ultrasound … unilateral or bilateral)
Gonioscopy: 92020 (Gonioscopy (separate procedure))

“Note that CPT^® 92100 describes serial tonometry. This requires multiple intraocular pressure measurements taken over an extended period of time on the same day. Do not use this to report IOP readings that are part of the office visit,” says Mary Pat Johnson, CPC, CPMA, COMT, COE, senior consultant with Corcoran Consulting Group.

Medicare’s National Correct Coding Initiative (NCCI) edits do not bundle these four tests with ophthalmological services, so when your ophthalmologist performs a comprehensive exam and testing on the same day, you can bill 92004/92014 together with any of the codes listed above, when performed.

If the examination and testing lead to a diagnosis of hypotony, scour the documentation for the details needed to pinpoint the correct code.

Check for Clues About the Cause

Your choices for an ocular hypotony diagnosis span over a dozen ICD-10 codes, and you must classify the type of hypotony, as well as the cause if you know it. Plus, most hypotony diagnoses require you to code to the 6th character, which may necessitate further documentation review.

Being able to choose the most specific ICD-10 code from the H44.4- (Hypotony of eye) subcategories hinges on how much you know about the condition. It’s up to the ophthalmologist to document enough information to code beyond the basic unspecified code, H44.40 (Unspecified hypotony of eye). When you’re going through the medical record, look for mention of the cause of the patient’s hypotony to help guide you to the correct code.

The first set of coding options listed in the ICD-10 code book involves flat anterior chamber hypotony (H44.41-), which typically happens after surgeries like primary glaucoma filtration (trabeculectomy). The incisions made on the eye may lead to leakage of aqueous humor and reduction of intraocular pressure.

You’ll use the codes in the next group (H44.42-) to report hypotony caused by an ocular fistula, which may occur naturally if the patient has a related condition, such as high blood pressure or vascular disease, or as a result of trauma. There are also codes to denote hypotony due to other eye issues (H44.43-) and primary hypotony (H44.44-).

Don’t Forget Those 6^thDigits

Once you’ve identified the correct code range for the patient’s condition, you’ll need to add a 6th digit, depending on which eye is affected. When choosing a hypotony code, your options include the following: 1 (right eye), 2 (left eye), 3 (bilateral), and 9 (unspecified eye).

For instance, if your ophthalmologist sees a patient with bilateral hypotony due to an ocular fistula, you’ll report H44.423 (Hypotony of eye due to ocular fistula, bilateral).

Tip: Payers want you to code as accurately as possible. If your physician frequently fails to document the type of hypotony or the affected eye(s), sit down with them and let them know that vague documentation and submission of unspecified codes could lead to delays in reimbursement, or even denials, advises Johnson.