Ophthalmology and Optometry Coding Alert

Question: A patient presents with high intraocular pressure, a symptom of glaucoma, and the ophthalmologist performs a visual field (VF) examination. The results of the visual field are normal, ruling out glaucoma. Which diagnosis code should I link to the VF procedure?

Minnesota Subscriber

Answer: Since the results of the visual fields were negative - they did not confirm glaucoma or any condition -- the ophthalmologist should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable visual field code, and include any additional observations from the visual fields in his office notes.

In this case, the appropriate diagnosis code is 365.01 (Borderline glaucoma [glaucoma suspect]; open angle with borderline intraocular pressure or cupping of optic disks).

But if a patient presents with signs and symptoms of glaucoma and a VF confirms the condition, you should report the code for the confirmed diagnosis.

For example, if an ophthalmologist performs visual fields for a patient who presents with high intraocular pressure, and the VFs confirm the presence of small scotomas, the VF code should be linked to the appropriate glaucoma diagnosis code, in this case 365.10 (Open-angle glaucoma, unspecified).

This diagnosis code is appropriate for VF examination codes 92081 (Visual field examination, unilateral or bilateral, with interpretation and report; limited examination [e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent]), 92082 (... intermediate examination [e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33]) and 92083 (... extended examination [e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).