Ophthalmology and Optometry Coding Alert

Knowing the right codes to report for blurry vision can save your practice from costly denials When a patient presents with vague, generalized complaints -- such as blurry vision, dry eyes or a foreign-body sensation -- it can sometimes be challenging to coders. Our experts explain how to handle three common complaints. Make Clear Choices for Blurred Vision If someone's vision is blurred, his first visit will probably be to an eye-care specialist. Yet ICD-9 codes that specifically describe blurred vision, and similar diagnoses that relate to refractive error, sometimes aren't covered. What's a coder to do? An option many coders choose is to report 368.8 (Visual disturbances; other specified visual disturbances).

The ICD-9 manual includes the note "blurred vision NOS (not otherwise specified)," indicating that this is a good choice for blurred vision. Some carriers don't agree, however, using the logic that there must be something causing the blurriness and insisting you report the cause, not the symptom.

Coder's Rule: If a patient has a medical problem, use the final diagnosis; if the patient has only blurred vision, use 368.8, says Davina Luciano, CPC, coder for Inland Eye Specialists in Hemet, Calif. For example, "If a patient comes in with a complaint of blurry vision, and the ophthalmologist finds a cataract, we use cataract (366.xx) as the primary diagnosis and blurred vision (368.8) as the secondary diagnosis," she says.

If the patient doesn't specifically complain of blurred vision but instead asks for a routine eye exam, it gets a little trickier. How you code "depends on the insurance," says Rita Knapp, CPC, coding specialist with Whitson Abrams Vision and Laser Centers in Indianapolis. "If the patient is coming in for a routine vision exam and we know we're going to bill a vision insurance, we would go ahead and bill with a routine diagnostic code for refractive error [367.x]. If the patient doesn't have a vision plan, then we probably would bill with 368.8."

Snag: Medicare's Routine Services Policy excludes coverage of routine eye exams or to correct refractive error. "The coverage of services rendered by an ophthalmologist is dependent on the purpose of the examination rather than on the ultimate diagnosis of the patient's condition," the policy states. "When a beneficiary goes to an ophthalmologist with a complaint or symptoms of an eye disease or injury, the ophthalmologist's services (except for eye refractions) are covered regardless of the fact that only eyeglasses were prescribed." LMRPs vary in which diagnosis codes are covered. Trailblazer, Medicare's contractor for Colorado, New Mexico and Texas, does not cover any of the 367.x codes. Meanwhile, Palmetto GBA(West Virginia) considers 367.0-367.4 (including diagnoses such as myopia, astigmatism and presbyopia) noncovered codes, but will accept [...]