You Be the Coder:
CME
Published on Sun Jul 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient needed extended ophthalmoscopy. The doctor thought there was a macular hole and sent the patient to a retina specialist. But, the retina specialist found that the patient had cystoid macular edema (CME). Which diagnosis should we use for the visit?
Texas Subscriber
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Answer: The only diagnosis you can use is the one reflected in the medical record. If the impression documented is macular hole, code 362.54 (macular cyst, hole, or pseudohole). However, if the impression is a suspected or probable macular hole, the symptom(s) should be coded by the first ophthalmologist. File an amended claim, but make it clear if you have already been paid that you are simply setting the record straight and not seeking additional payment.
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