Ophthalmology and Optometry Coding Alert

Can you select the appropriate diagnosis after reading the case?

Treating cornea diagnoses is an important part of every eye care practice, but coding them can sometimes stop you in your tracks. Many of these conditions have tricky coding rules, which can often cloud your code selection decisions.

Check out the following three scenarios and determine how you would code these cases.

Double Pterygium

Scenario: A 48-year-old patient who drives a tour boat for a living comes to the practice complaining of pain in his left eye every time he blinks. He says his wife noticed a small bump on his cornea and it has gotten more irritating as the weeks have gone on. On examination, the eye care physician discovers two pterygia, both in the left eye but in different quadrants of the cornea. The physician diagnoses the patient with double pterygium. Which code should you report?

Coding Solution: This condition, also known as "Surfer's eye," can be commonly seen in patients who spend a lot of time on the water. Although some coders have been known to report a standard unspecified bilateral pterygium code (H11.003) due to the patient having two pterygia, that would be incorrect in this case. Because the patient had both pterygia in the left eye, the appropriate code would be H11.032 (Double pterygium of left eye). You don't need to separately report the symptoms for pain and irritation since a more definitive diagnosis was ultimately discovered.

Fuchs' Dystrophy

Scenario: A 58-year-old patient presents to the practice with a swollen cornea in the right eye and says she has been experiencing blurry vision for several months in that eye, although it hasn't interfered with her daily activities until the past few days. On examination, the ophthalmologist discovers that the patient has several blisters marking the right cornea. She diagnoses the patient with Fuchs' Dystrophy. Which ICD-10 code should you report?

Coding Solution: Fuchs' Dystrophy doesn't have an exclusive ICD-10 code, but it falls under the general code for endothelial corneal dystrophy (H18.51). If you flip to that code descriptor in your ICD-10 manual, a note under the code descriptor indicates that this code includes Fuchs' Dystrophy diagnoses.

Corneal Abrasion

Scenario: A 55-year-old new patient presents to the office with pain, redness, and tearing in her right eye. She says she mowed the lawn earlier that day and thought she was just suffering from allergies, but later in the day she noticed that her vision was blurred and she developed a headache. On examination, the physician discovers that the patient suffered a corneal abrasion in the right eye. Which code applies?

Coding Solution: To report a corneal abrasion, you'll look outside of the "H" section of ICD-10 (Diseases of the Eye and Adnexa), where most eye conditions are located. Instead, you'll flip to the "S" section of the book (Injury, Poisoning, and Certain Other Consequences of External Causes) since an external force caused the eye injury. The appropriate code for this condition is S05.01XA (Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter).