Ophthalmology and Optometry Coding Alert

Question: How should I bill for a routine exam with the diagnosis post-keratoplasty in the right eye, and keratoconus in the left eye? What would the correct diagnosis codes be?

Alabama Subscriber

Answer: Report ICD-9 code 371.60 (Keratoconus, unspecified), 371.61 (Keratoconus, stable condition) or 371.62 (Keratoconus, acute hydrops) for the keratoconic left eye. To show the post-keratoplasty status in the right eye, report V42.5 (Organ or tissue replaced by transplant; cornea).

Watch for: There is still some concern that payers will not reimburse for services linked to V codes. And there are few V codes that may be considered non-payable by Medicare. However, compliance with ICD-9 coding requires the physician to report the most appropriate code to describe the reason for the service. It is inappropriate to code an encounter for purposes of receiving payment. So, if the V code describes the most appropriate reason for the encounter, then that is the diagnosis code that you should link to the E/M or procedure code.

Learn more: For authoritative guidance for reporting ICD-9 diagnosis codes, download "The Official ICD9CM Guidelines for Coding and Reporting" at www.cdc.gov/nchs/data/icd9/icdguide10.pdf.

If you feel that the patient's presenting problem may not be covered by Medicare, obtaining an Advance Beneficiary Notice of Noncoverage (ABN) prior to the service is the responsibility of the practice.

Note: If you're fitting a keratoconus patient for contact lenses, stay away from 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia). Use that code only when prescribing contacts to correct a refractive error. If the patient has keratoconus, which is a medical condition, bill 92070 (Fitting of contact lens for treatment of disease, including supply of lens).