Ophthalmology and Optometry Coding Alert

Question: A patient with one good eye and one prosthetic eye came in for a yearly check. She came in requesting a contact lens for her good eye. There were no vision changes or other problems. I cannot find any medical reason besides the prosthetic eye to code this, yet she insists this falls under her medical insurance.

New York Subscriber

Answer: If the patient has a chronic condition, along with a vision diagnosis for the healthy eye, and if the ophthalmologist commented on the prosthetic eye during the exam, code it as a medical problem using either 367.51 (Disorders of accommodation; paresis of accommodation) or 367.52 (... total or complete internal ophthalmoplegia).
 
If this is a Medicare patient, and the only thing documented is the current complaint (CC) and history of present illness (HPI) portions of the examination, code the vision diagnosis (e.g., 367.1, Myopia).