Ophthalmology and Optometry Coding Alert

Question: I am often asked to evaluate patients to rule out retinopathy of prematurity (ROP). If there is no evidence of pathology, how should this be codedwhich ICD-9 diagnosis?

Hugh M. Cooper, MD
Southbridge, MA

Answer: If the child doesnt have ROP, then you should use the appropriate premature birth weight code from the 765 ICD-9 category plus V71.8 (observation for other specified suspected conditions), says Cindy Tanner, transcriptionist at Pediatric Ophthalmology, a one-provider practice in Erie, PA, which sees a lot of children to rule out this condition. This code is under the observation and evaluation for suspected conditions not found category in the ICD-9-CM. This category is to be used when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation is found not to exist, ICD-9 states. There is no problem with getting paid using this code in our geographic area, Tanner says. Note that if the child is found to have ROP, then you should use 362.21 (retrolental fibroplasia).