Ophthalmology and Optometry Coding Alert

Question: A new patient came in with pain, redness, and tearing in her right eye. She mowed the lawn earlier that day and thought she was just suffering from allergies, but later in the day she noticed that her vision was blurred and she developed a headache. On examination, the physician diagnosed a corneal abrasion in the right eye. Which ICD-10 code should we report?

South Carolina Subscriber

Answer: To report a corneal abrasion, you’ll look outside of the “H” section of ICD-10 (Diseases of the Eye and Adnexa), where most eye conditions are located. Instead, you’ll flip to the “S” section of the book (Injury, Poisoning, and Certain Other Consequences of External Causes) since an external force caused the eye injury. The appropriate code for this condition is S05.01XA (Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter).