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Optometry Coding & Billing Alert

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Take Pressure Off Glaucoma Dx Coding

Published on Thu Mar 04, 2004

Question: We had a patient present with high intraocular pressure, a symptom of glaucoma, and the optometrist decided to perform a visual field (VF) examination. The results of the visual field were normal, and the doctor ruled out the possibility of glaucoma. Which diagnosis code should I link to the VF procedure?
      
Minnesota Subscriber

Answer: Because the results of the VFs were negative -- they did not confirm glaucoma or any condition -- you should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable VF code, and include any additional observations from the VFs in the office notes.

In this case, the appropriate diagnosis code is 365.01 (Borderline glaucoma [glaucoma suspect]; open angle with borderline intraocular pressure or cupping of optic disks). But if a patient presents with signs and symptoms of glaucoma, and a VF confirms the condition, you should report the code for the confirmed diagnosis.  

For example, if you perform visual fields for a patient who presents with high intraocular pressure, open angles, and the VFs confirm the presence of small scotomas in the areas of the VF important in glaucoma, the diagnosis code should be linked to the appropriate glaucoma diagnosis, in this case 365.10 (Open-angle glaucoma, unspecified). Scotomas in other areas may suggest another diagnosis.

Diagnosis code 365.10 is appropriate for the following VF examination codes:

  • 92081 -- Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
  • 92082 -- ... intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
  • 92083 -- ... extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program   G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).

    The extended procedure, 92083, is more appropriate because it is more complete.

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