Ophthalmology and Optometry Coding Alert

See if you can spot the best-suited codes for these scenarios.

Although coding for ophthalmology is usually straightforward, there are times when selecting the most appropriate code among the thousands of options in your ICD-10 code book is more challenging. Taking steps to ensure your ICD-10 knowledge is top-notch will prevent the trickier cases from stopping you in your tracks and set you on a path toward claim success.

To help you gauge your level of expertise in coding eye-related diagnoses, we’ve put together a quick quiz. Try answering the following case scenarios before reading the solutions.

Recognize Bilateral Xanthelasma Code Requirements

Question 1: A 62-year-old female patient presents complaining of yellow-hued bumps on her upper eyelids. She reports that she has no other symptoms but noticed the lumpy patches about a month ago, and after tracking them, she noted that they weren’t getting any smaller. A history reveals that the patient has high cholesterol, and the physician diagnoses the patient with xanthelasma. How should you report this condition?

Solution: When reporting the presence of xanthelasma bilaterally, remember that two codes are necessary, as the ICD-10 code book does not supply a single code to describe this condition when it affects both upper eyelids. In this case, the patient has xanthelasma of only the upper eyelids, so you’ll report the bilateral condition with two codes: H02.61 (Xanthelasma of right upper eyelid) and H02.64 (Xanthelasma of left upper eyelid).

Know How To Report Blepharitis and Conjunctivitis

Question 2: A 57-year-old patient presents with an itchy, red, swollen left eye, which he reports has been so productive that it is sealed shut when he wakes up in the morning. On examination, the ophthalmologist notes scaly, dry skin on the patient’s left upper and lower eyelids and corneal irritation. The physician diagnoses the patient with blepharoconjunctivitis and prescribes eyelid scrubs and antibiotic ointment. Which diagnosis code should you report?

Solution: Blepharoconjunctivitis typically starts with eyelid inflammation (blepharitis) and gradually progresses to the conjunctiva (conjunctivitis). Correctly coding this condition requires that you know the type and recognize that ICD-10 includes combination codes that denote inflammation of both the eyelid (upper and/or lower) and conjunctiva, so you don’t need to two separate codes to indicate the presence of blepharitis and conjunctivitis.

Because the physician didn’t specify a type of blepharoconjunctivitis, such as angular, ligneous, or contact, you should submit the unspecified code. Only the patient’s left eye was affected, so you’ll use H10.502 (Unspecified blepharoconjunctivitis, left eye). Note that you don’t need to report two different codes when both the upper and lower eyelids are affected, as this code is appropriate to cover the full extent of this condition on one eye.

Ask Providers To Specify Stable vs. Unstable Keratoconus

Question 3: A 67-year-old patient presents complaining of low vision, halos around automobile headlights when driving, and double vision in both eyes. After measuring the cornea and comparing it to previous corneal measurements, the physician diagnoses the patient with bilateral keratoconus. Which code should you report?

Solution: In keratoconus, the normally round cornea gets thinner and gradually bulges outward into a cone shape. When your ophthalmologist diagnoses this condition, they need to specify whether it is stable or unstable to enable you to report it with maximum specificity.

For this patient, you’ll use H18.603 (Keratoconus, unspecified, bilateral) to report keratoconus in both eyes. The unspecified code is the most accurate, given the amount of information provided. But if the physician documents stable keratoconus, you’ll instead report H18.613 (Keratoconus, stable, bilateral), and if it’s unstable, you’ll submit H18.623 (Keratoconus, unstable, bilateral).

Knowing the Type of Age-Related Cataracts Is Key

Question 4: A 77-year-old patient presents for an eye exam and reports that her vision has been steadily declining for the past few years. At first, it just affected her ability to read, but now she has reduced vision in bright light and halos around lights at night. The ophthalmologist examines the patient and discovers that she has posterior subcapsular age-related cataracts in both eyes. Which code describes this condition?

Solution: A cataract is a clouding of the lens of the eye, which is typically clear. Age-related is by far the most common type of cataract, and it is divided into three main types based on the part of the lens affected: nuclear, cortical, and subcapsular. Proper reporting requires documentation of the type of age-related cataract and eye(s) affected. In this case, you should report H25.043 (Posterior subcapsular polar age-related cataract, bilateral) to describe the patient’s condition.

Be Able To Decipher Strabismus Details

Question 5: A 6-year-old patient presents with his mother for evaluation of strabismus. The physician examines the patient and performs a series of tests including the Hirschberg and Bruckner tests. The ophthalmologist diagnoses the patient with alternating esotropia with a V pattern. Which code applies?

Solution: Esotropia is a type of strabismus (eye misalignment) in which one or both eyes turn inward toward the nose. For this patient, H50.07 (Alternating esotropia with V pattern) is the best option to describe their condition.