Optometry Coding & Billing Alert

Published on Sun Jan 04, 2009 PDF

Question: What is the proper ICD-9 code for pellucid marginal degeneration?

Arizona Subscriber

Answer: Use 371.40 (Corneal degeneration, unspecified) when you code pellucid marginal degeneration cases.

Pellucid marginal degeneration is a subtle condition that could lead to corneal ectasia following laser eye surgery. Although it is atypical and rare, clinicians should learn how to identify pellucid and screen patients for it preoperatively.

In pellucid marginal degeneration, corneal thinning typically occurs from the 4 to the 8 o'clock position approximately 1 mm from the inferior limbus. Another difference between pellucid marginal degeneration and keratoconus is that the onset of pellucid tends to be in patients aged in their 30s, rather than around the time of puberty.

The key to recognizing early cases of pellucid is topography. Patients may appear clinically normal and have normal pachymetry, if it is performed centrally or paracentrally. However, since the cornea typically gets thicker from the center to the periphery, clinicians should be suspicious if there is little difference between the central and inferior pachymetry.