Ophthalmology and Optometry Coding Alert

Question: How should I bill Blue Cross Blue Shield for a routine exam with the diagnosis beinghistory of blepharitis and current keratoconus of the left eye? What would the correct diagnosis codes be?

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Answer: The appropriate diagnoses should reflect the current condition of the eye, not the history or risk factors. The condition would most likely qualify as a code from the H18.6x series (Keratoconus), with the specific code depending on whether the condition is stable, unstable, or unspecified, and which eye was affected. Since you know the keteroconus is in the left eye, you’ve got one part of the code nailed down, and once you find out the specifics of the condition, you’ll have the rest.

However: If this is indeed the diagnosis, this is not a routine exam, so you should also report Z01.01 (Encounter for examination of eyes and vision with abnormal finding).