Ophthalmology and Optometry Coding Alert

Question: We keep getting denials for 92082 and 92083 (Visual field examination ...) linked to the diagnosis code 365. What can we do to get paid?

Delaware Subscriber

Answer: If you're using 365 as a diagnosis code, your visual fields claims are getting denied because the code isn't specific enough. The  365 series (Glaucoma) includes codes require specificity carried out to the fifth digit to describe the glaucoma as accurately as possible, such as 365.02 (Borderline glaucoma [glaucoma suspect]; anatomical narrow angle) and 365.21 (Intermittent angle-closure glaucoma). Whenever fourth or fifth digits are available for an ICD-9 code, insurers look for them on claims; if they don't find them, they will probably reject the claim.

Tip: In the ICD-9 manual, look beside the code for a checkmark or other icon. The icon draws your attention to the fact that you need at one or more additional digits for coding accuracy and for payment to be considered.

-- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.