Ophthalmology and Optometry Coding Alert

Maybe the patients parents both have cataracts. Maybe a best friend just had cataract surgery. Or maybeas in the case described in the June issue (page 43 of Ophthalmology Coding Alert), an optometrist told the patient she had a cataract. In any event, the ophthalmologist looks and doesnt find one. This makes for some confusion when it comes to coding. In the story in the June issue, it was explained that if a patient comes in with no complaints at all, you cant bill Medicareeven if you do find something. Thats why its so important for the technician to do a thorough interview before the ophthalmologist even sees the patient. The article also stated you cant commonly use the diagnosis code of cataract for this patient.

Well, Larry Patterson, MD, of Eye Centers of
Tennessee in Crossville, disagrees. Even if they see nothing there, I would code it as a cataract, says Patterson. You code the visit as being the reason for the patient being there. Thats the reason.

Some patients do, indeed, come in and say that they want to be checked for a cataract. If I find none, and I tell them to come back in a year and check again, then the diagnosis code for the next year is cataract, he says. But if they just wonder if they might have a cataract, thats routine, and that is not billable. If an optometrist actually tells a patient that she has a cataract, the patient shouldnt be penalized just because the optometrist was wrong, Patterson believes. I would use the cataract diagnosis for what the OD says, even if its not right.

Medicare has made it very clear that reimbursement is based on a patients complaint, notes Patterson. But just because a patient doesnt have any vision complaints doesnt mean the diagnosis code still would be for a cataract, he says. I put cataract: non found in the chart, he added.

Vickie Wadsworth, office manager for Northern Wyoming Ophthalmology of Cody, WY, thinks that its likely that the ophthalmologist would find something wrong. First of all, there are different extremes of cataracts, she says. Many physicians do not realize there is an ICD-9 code for incipient cataract (366.12). When the cataract is that negligible, many physicians dont want to alarm the patient with a cataract diagnosis and so dont include the findings in the medical record. Secondly, its most likely not going to be a normal eye exam anyway. There could be diagnoses other than cataracts. The diagnosis codes should be for whatever the ophthalmologist does find in the exam. And Wadsworth stresses that the diagnosis does not have to be the same as the chief [...]