Ophthalmology and Optometry Coding Alert

Condition Spotlight:

Up Your Conjunctivitis Coding Game With These Tips

Published on Wed Mar 22, 2023

Learn which details help you choose between the B30.- and H10.- code groups.

Ophthalmologists and optometrists are no strangers to conjunctivitis, so knowing how to properly code this common ocular infection is extremely important if you want to avoid losing time and money.

That’s why we asked expert coders to explain how they narrow down the codes and which details in the documentation they scour for to ensure correct coding of the various types of conjunctivitis every time. Here’s what they had to say.

Check for Clues About the Cause

Condition refresh: Conjunctivitis occurs when the transparent membrane (conjunctiva) that covers the front surface of the eyeball and lines the inner part of the eyelids is irritated by an infection or allergies. Symptoms can vary but typically include redness and swelling, and sometimes discharge from the eye.

Part of what makes this eye condition tricky to code is that it is “divided into two categories: infectious, which can be viral or bacterial; or noninfectious, such as conditions caused by allergies or a foreign body,” explains Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

What’s confusing for coders is that some forms of conjunctivitis are found among the infectious and parasitic diseases in Chapter 1 of ICD-10-CM, while others are found among the diseases of the eye and adnexa in Chapter 7. There’s even one form of conjunctivitis that affects neonates and is caused by contamination of the baby’s eyes by the gonococcus bacterium during passage through the birth canal; you’ll code this with P39.1 (Neonatal conjunctivitis and dacryocystitis).

Simply put, the B30.- (Viral conjunctivitis) codes are “for viral conjunctivitis and must be specified by the provider as such,” while the H10.- (Conjunctivitis) codes “describe bacterial and allergic conjunctivitis as well as unspecified conjunctivitis,” explains Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, manager of clinical compliance with PeaceHealth in Vancouver, Washington.

Find Out if Papillae or Follicles Are Present

Most cases of conjunctivitis are categorized as either classified as follicular, which is caused by a virus, atypical bacteria, or medication reaction, or papillary, which is caused by an allergic response or response to a foreign body such as a contact lens. If your provider notes small, dome-shaped nodules on the eye itself, then you are dealing with the follicular form, while a cobblestone arrangement of flattened nodules on the surface of the eyelid is indicative of the papillary variety.

One quick and easy way to differentiate between these kinds of conjunctivitis, according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California, is to review the entire medical record before assigning a code. “Look for symptoms such as mucus or pus (H10.01-) or a thin watery discharge (H10.23-),” Johnson advises, “which can affect the selected code.”

Note: You never want to assume viral, bacterial, or allergic conjunctivitis based on words such as “nodules” or “papillae,” so double-check with the provider if there is any confusion or discrepant information.

Assess Whether It’s Acute or Chronic

Conjunctivitis can come on quickly, or it can occur regularly, so you will need to look for clues in the documentation. Review the chief complaint and history of present illness for the onset of symptoms. It may also be useful to review notes from previous visits to determine if the condition was present at the last encounter.

Acute conjunctivitis generally lasts one to two weeks, whereas chronic lasts four or more weeks. But be careful not to jump to conclusions, like with all ICD-10-CM codes, that designation needs to be specifically documented by the provider. As a coder, you cannot extrapolate and assign any condition as acute or chronic based on how long the patient has experienced symptoms.

Pinpoint the Correct Code

Viral Conjunctivitis – For viral cases, turn to ICD-10-CM Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) for proper coding:

B30.0 (Keratoconjunctivitis due to adenovirus)
B30.1 (Conjunctivitis due to adenovirus)
B30.2 (Viral pharyngoconjunctivitis)
B30.3 (Acute epidemic hemorrhagic conjunctivitis (enteroviral))
B30.8 (Other viral conjunctivitis)
B30.9 (Viral conjunctivitis, unspecified)

Viral conjunctivitis is often associated with an upper respiratory infection, so these are the codes to turn to for patients with cold and flu symptoms such as a sore throat, fever, and headache. Infections caused by adenovirus serotypes 8, 19, and 37 are coded to B30.0, while infections caused by adenovirus serotypes 3, 4, and 7 are coded to B30.2. All other adenoviral conjunctivitis conditions are coded to B30.1, whereas infections caused by coxsackievirus A24 and enterovirus 70 are coded to B30.3.

Bacterial and Allergic Conjunctivitis – The H10.- codes (Conjunctivitis), such as the following, describe forms of bacterial and allergic conjunctivitis. Some of the codes require a 6th character:

H10.01- (Acute follicular conjunctivitis)
H10.02- (Other mucopurulent conjunctivitis)
H10.1- (Acute atopic conjunctivitis); includes acute papillary conjunctivitis
H10.2- (Other acute conjunctivitis)
H10.3- (Unspecified acute conjunctivitis)
H10.4- (Chronic conjunctivitis)
H10.5- (Blepharoconjunctivitis)
H10.8- (Other conjunctivitis)
H10.9 (Unspecified conjunctivitis)

One quick and easy way to differentiate between these kinds of conjunctivitis, according to Johnson, is to check for key terms in the medical record before assigning a code. “Look for symptoms such as mucus or pus (H10.01-) or a thin watery discharge (H10.23-),” Johnson advises, “which can affect the selected code.” And if the exact bacteria is not known, assign an unspecified code, such as H10.33 (Unspecified acute conjunctivitis, bilateral). If there is a subsequent encounter and the bacteria is known at that time, that information could then be coded.

Note which eye is affected: The codes for bacterial and allergic conjunctivitis take a 6th character to account for laterality: 1 for the right eye, 2 for the left eye, 3 for both eyes, and 9 for unspecified side. If this information is missing, it’s always best to ask rather than assign 9 as the 6th character.

So, to code pink eye — the form of conjunctivitis eye care providers see most often — in both eyes, you’ll report H10.013 (Acute follicular conjunctivitis, bilateral). If the physician documents excessive discharge, the condition could be mucopurulent conjunctivitis, which you’ll code to H10.023 (Other mucopurulent conjunctivitis, bilateral), depending on the provider’s documentation. When bacteria cause irritation and inflammation of the eyelid, which then spreads to the conjunctiva, and you see mention of blepharoconjunctivitis you’ll choose from the H10.5- code series. The 5th digit adds specificity to the condition, the 6th digit identifies which eye(s).

Learn the lingo: Bacterial conjunctivitis is commonly referred to as pink eye, while allergic conjunctivitis is commonly referred to as red eye. The allergic form is commonly coded to H10.1-, though chronic allergic conjunctivitis can be coded to H10.44 (Vernal conjunctivitis) if the patient is allergic to airborne allergens such as pollen or pet dander, or even H10.45 (Other chronic allergic conjunctivitis).