Ophthalmology and Optometry Coding Alert

Question: What is a coloboma and what codes should I report for patients with this condition?

Oklahoma Subscriber

Answer: When patients have a coloboma, that means they have a defect — an area of missing tissue — in one of the structures that form the eye, most commonly the eyelid or iris. While these types are more obvious since it’s noticeable when part of the iris or eyelid is missing, colobomas can also affect the other areas that aren’t as easy to see on visual examination of the patient and can be slower to diagnose. The signs and symptoms will vary depending on what tissue is affected.

When patients present with a coloboma, they could complain of the following symptoms, among others, which you should report in the absence of a confirmed diagnosis:

• H53.8 (Other visual disturbances)
• H54.5- (Low vision, one eye)
• H53.45- (Other localized visual field defect)

If the ophthalmologist definitively diagnoses the patient with a coloboma, you’ll bill the claim using a more specific code, depending on the part of the eye affected. Your options include:

• Q12.2 (Coloboma of lens)
• Q13.0 (Coloboma of iris)
• Q14.2 (Congenital malformation of optic disc)
• Q14.8 (Other congenital malformations of posterior segment of eye) i.e., coloboma of the fundus

In cases where the patient is experiencing other conditions associated with the coloboma, you can report them as well (such as glaucoma or strabismus).

Key: Do not report the signs and symptoms if the physician has definitively diagnosed the patient with coloboma.