Ophthalmology and Optometry Coding Alert

Documentation must differentiate between types of irritation before you can select the right ICD-10 code.

With the allergies of spring still blooming, eye care practices are likely to see scores of patients with irritated eyes. When it comes down to selecting the best diagnosis code, step one will always be to find granular details in the documentation that differentiate the specific condition from other, similar diagnoses.

Get Specific With 3 Key Conditions

For your claims to be processed successfully, you must report the most specific diagnosis code available for your patient’s eye irritation, advises Allison Anderson, owner of AAA Billing in Newark, N.J. Most patients you see with eye irritations will have one of three major conditions:

1. Blepharitis (H01.0x): This is an inflammation of the eyelids, particularly at the lid margins, caused by an overgrowth of bacteria in the skin, typically associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in several variations, and the three that you’ll see most frequently in your medical charts are ulcerative, squamous and unspecified. Ulcerative blepharitis (H01.01x) typically has lesions and small ulcerated regions along the eyelid margins, while squamous blepharitis (H01.02x) manifests in small white or gray scales along the eyelid’s edge. When the doctor doesn’t specify which type of blepharitis the patient has, you’ll typically report unspecified blepharitis (H01.00x).

Once you confirm that the patient has a specific type of blepharitis, you’ll then expand the codes out to the sixth digit by determining the location of the blepharitis. For instance, unspecified blepharitis of the left lower eyelid would be coded with H01.005, ulcerative blepharitis of the right upper eyelid would translate to code H01.011, and squamous blepharitis of the left upper eyelid would be coded with H01.024.

2. Dry eye (H04.12x): Dry eyes are caused by decreased tear gland fluid production, creating dry spots on the eye. An imbalance in the substances that make up the tear film can also cause dry eyes. Treatment of dry eye aims to restore a more normal tear film to minimize dryness, blurred vision, and discomfort.

Your ICD-10 manual will refer you to the H04.12x series for dry eye syndrome, but you’ll need to add a sixth character signifying the location of the condition before payers will accept this code. For instance, if a patient has dry eye syndrome of the left lacrimal gland, you’ll submit H04.122, while bilateral dry eye syndrome would be coded with H04.123.

3.  Conjunctivitis (H10.xx): Otherwise referred to as “pink eye,” this ailment is characterized by redness and inflammation of the membranes (conjunctiva) covering the whites of the eyes and the membranes on the inner part of the eyelids. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents, as well as to underlying diseases within the body. Viral and bacterial forms of conjunctivitis are common in childhood, but they can occur in people of any age.

There are several types of conjunctivitis, and you should know which your patient has before selecting the right code. You’ll need to know whether the patient has acute or chronic conjunctivitis, as well as whether they have follicular or papillary. Follicular conjunctivitis is often caused by viruses or medication reactions, and is characterized by small, dome-shaped nodules in the eye, while papillary is often due to an allergic immune response or a foreign body, and is characterized by papillae on the eyelid surface.

Once you know whether the condition is acute or chronic and follicular or papillary, then locate the affected eye and you can select the right code. For instance, acute follicular conjunctivitis of the right eye would be coded with H10.011.

Keep in mind that there are also other types of conjunctivitis, including include mucopurulent (H10.02x), atopic (H10.1x), toxic (H10.21x), pseudomembranous (H10.22x), or serous (H10.23x), among others. If you see notation of these types of conjunctivitis, you’ll report the appropriate code and not one from the unspecified series.

Consider Primary Reason for Visit

Experts advise: If the primary diagnosis is a routine check-up and blepharitis or conjunctivitis is a secondary finding, the practice should still code for a routine visit.

Example: A new patient comes in for a routine eye exam. The optometrist performs a comprehensive exam and discovers ulcerative blepharitis of the left upper eyelid. Report 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits), and link it to Z01.01 (Encounter for examination of eyes and vision with abnormal finding). As a secondary diagnosis, report the blepharitis with H01.014.