Ophthalmology and Optometry Coding Alert

Hint: Cataract codes may depend on cause.

As coders work to navigate changing regulations and coding conventions amid the coronavirus epidemic, one thing that has remained the same is the importance of accurate diagnosis coding. To ensure that you’re reporting the ICD-10 codes that will justify the procedures you perform, check how you’d answer these coding scenarios before reading the solutions.

Get Specific When Cataracts Stem from Drug Use

Scenario: A 72-year-old male patient taking glucocorticoids complains of blurred vision. The ophthalmologist diagnoses the patient with bilateral cataracts due to long-term glucocorticoid use.

Report this: When patients’ cataracts stem from drug use, you’ll report a code from the H26.3 (Drug-induced cataract) range. Because the patient’s cataracts affect both eyes, the most appropriate code is H26.33 (Drug-induced cataract, bilateral).

In addition, the ICD-10 code book indicates that you should report an additional code to reflect the adverse effect identifying the drug. Therefore, you’ll report T38.0X5 (Adverse effect of glucocorticoids and synthetic analogues) as the secondary diagnosis code.

Keep Sequencing in Mind for COVID-19 Cases

Scenario: A patient presents to your practice with a six-day history of a red, itchy, sticky right eye; lethargy; and a low-grade fever. The patient reports no cough and no exposure to anyone with coronavirus, but on examination, the ophthalmologist notes atopic conjunctivitis and some wheezing in the patient’s chest. The physician refers the patient for a coronavirus test and prescribes antibiotic eyedrops, as well as Tylenol for the fever. Three days later, the physician learns that the patient tested positive for COVID-19. Which ICD-10 code(s) apply?

Report this: Conjunctivitis has been reported as a rare symptom of the coronavirus, but that doesn’t mean you should code it as the primary diagnosis in a coronavirus patient. In reality, your first diagnosis code should be U07.1 (COVID-19) and your second ICD-10 code should be H10.11 (Acute atopic conjunctivitis, right eye). That’s because U07.1 should always be the primary diagnosis code for patients confirmed with conjunctivitis.

Do “Z” Codes Justify Surgery?

Scenario: The physician performs a cataract surgery on a patient and circles Z98.4 (Cataract extraction status) as the code to report for the service. Is this accurate?

Report this: If you’re coding for the actual procedure, it wouldn’t be appropriate to code anything from the Z98.4 family. Those codes are typically reserved to describe patients with a history of cataract surgery. If you saw a patient who’d had cataract surgery in the past, then came in postoperatively or later for a follow up or a problem that may be affected by the prior surgery, then you would use a Z98.4 code.

When you’re coding for the actual surgical procedure, as this case study suggests, you would instead want to use one of the cataract diagnosis codes from the H25 (Age-related cataract) or H26 (Other cataract) families, depending on the specifics documented in the operative note.