Ophthalmology and Optometry Coding Alert

Unsure of how to report Brown’s sheath syndrome? Check these options.

Most eye care practices report continuing success using ICD-10 codes, but some others have said that their offices are falling back on old ICD-9 conventions and failing to code as specifically as ICD-10 requires. To ensure that you’ve got your ICD-10 coding skills sharpened, take this quick quiz and then evaluate your responses.

1. The patient has chalcosis but the doctor doesn’t specify which eye is impacted. Which code should you report?

A. H44.329 (Siderosis of eye, unspecified eye)
B. H44.311 (Chalcosis, right eye)
C. H44.399 (Other degenerative disorders of globe, unspecified eye)
D. H44.319 (Chalcosis, unspecified eye)

Answer: The best answer here is D — H44.319 (Chalcosis, unspecified eye). When the doctor fails to specify which eye is affected, you have to default to the unspecified code. However, this should prompt you to have a frank discussion with the physician about better documentation to denote which eye has the globe metallosis, since insurers want physicians to document more accurately.

2. Your patient reports night blindness but she experiences it only after watching television. Which code should you report?

A. H53.60 (Unspecified night blindness)
B. H53.63 (Congenital night blindness)
C. H53.62 (Acquired night blindness)
D. H53.69 (Other night blindness)

Answer: Although you may be leaning toward H53.60 (answer A), the reality is that the doctor did specify the type of night blindness, but ICD-10 doesn’t include a specific code for it. Therefore, the correct answer is D — H53.69 (Other night blindness). The physician is aware of why the patient is experiencing night blindness (due to the bright lights of the television), but that condition does not have its own code in ICD-10.

3. The patient presents with Brown’s sheath syndrome of the right eye. Which code should you report?

A. H50.611 (Brown’s sheath syndrome, right eye)
B. H50.612 (Brown’s sheath syndrome, left eye)
C. H50.69 (Other mechanical strabismus)
D. H50.811 (Duayne’s Syndrome, right eye)

Answer: You should report A — H50.611 (Brown’s sheath syndrome, right eye) for this case. The patient has Brown’s sheath syndrome, a rare condition in which patients present with improper eye movements. Because the condition is present only in the patient’s right eye, A is the correct answer.

4. The patient is observed to have hypertropia of the left eye. Which code should you report?

A. H50.012 (Monocular esotropia, left eye) 
B. H50.112 (Monocular exotropia, left eye)
C. H50.22 (Vertical strabismus, left eye)
D. H50.412 (Cyclotropia, left eye)

Answer: Hypertropia refers to an eye that turns upward, and you should code this condition as vertical strabismus, so the accurate answer here is C — H50.22 (Vertical strabismus, left eye). Among the incorrect answers, esotropia describes an eye that turns inward, exotropia is an eye that turns outward, and cyclotropia is when one eye’s position is rotated around its axis when compared to the other eye.

5. A patient suffers from hemeralopia. What is the accurate code for this?

A. H53.10 (Unspecified subjective visual disturbances)
B. H53.11 (Day blindness)
C. H53.123 (Transient visual loss, bilateral)
D. H53.149 (Visual discomfort, unspecified)

Answer: Because hemeralopia describes day blindness, the correct answer here is B — H53.11 (Day blindness). Although hemeralopia is described as a type of visual disturbance or visual loss, some coders may inadvertently gravitate toward answers A or C, but those are not the most accurate ways to report this condition.