Ophthalmology and Optometry Coding Alert

Question: What are the diagnosis-code requirements for billing preoperative exams? Is it one diagnosis code or two?

Indiana Subscriber

Answer: Claims are routinely denied due to a misunderstanding of the number of diagnosis codes required for the preoperative exam, but even when coders correctly apply ICD-9 codes to these tests they often overlook the important documentation requirements.

You should be using only one diagnosis code for a preoperative examination, and it should correspond to the condition for which the patient is being seen by the ophthalmologist.

There must also be documentation in the patients chart from a previous visit that indicates the preoperative exam is medically necessary and is required to evaluate a medical problem prior to surgery. If there is no documentation demonstrating that the preoperative evaluation is necessary for reasons other than routine clearance, and no systemic conditions are recorded, the preoperative exam would be considered included in the global surgical package for the surgical procedure and would not be separately payable.

Answers to You Be the Coder and Reader Questions provided by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.