Ophthalmology and Optometry Coding Alert

Answer: The appropriate diagnosis code for ametropia, a refractive error when viewing distant objects, is 367.9 (Unspecified disorder of refraction and accommodation).

 

If you have a more specific diagnosis, you should report that instead, such as 367.1 (Myopia).

 

Watch for: If the ophthalmologist dictates his notes, be sure the transcriptionist distinguishes between ametropia and emmetropia, the eye’s normal refractive state, in which no refractive error is present.

 

If the patient is indeed emmetropic, find out what brought him into the office, such as generalized eye pain (379.91, Unspecified disorder of eye and adnexa; pain in or around eye), asthenopia (368.13, Visual discomfort) or a headache (784.0). Use the complaint to select the diagnosis code