Optometry Coding & Billing Alert

Question: Many of our patients claim general reasons for their visit, such as "I can't see well," or "My vision is foggy." We code these visits with 368.8 (Blurred vision NOS) as the primary diagnosis because this is the primary reason for the visit. Any other problems or underlying causes of the blurry vision we report as secondary diagnoses. Is 368.8 the most appropriate code to use in these situations, and should we list it first?

Maryland Subscriber

Answer: You should only report 368.8 as a primary diagnosis code when the optometrist doesn't find a more definitive diagnosis during the course of the visit. Carriers often consider a visit for blurred vision the same thing as a routine exam - and Medicare will not pay for this service. 

Whenever possible, you should list a more definitive diagnosis as primary and then the patient's complaint of blurred vision as secondary. For example, if the optometrist discovers that a cataract is causing the patient's blurry vision, you would first list 366.12 (Incipient cataract) and then 368.8. A coding rule of thumb is to always list first the condition causing the patient's signs or symptoms.

You should always strive to report the most descriptive and accurate ICD-9 codes possible. If a patient claims her only reason for the visit is a routine exam, experts recommend that the optometrist ask her a series of detailed questions to uncover any complaints she may have but doesn't think of right away. If she denies any blurriness of vision, the optometrist should ask, "Do your eyes ever itch, burn or water?" This may lead you to report dry-eye syndrome (375.15, Tear film insufficiency, unspecified) or allergic conjunctivitis (372.14, Other chronic allergic conjunctivitis).