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Use these tips to distinguish between codes for viral, bacterial, and allergic conjunctivitis.

Conjunctivitis, better known as “pink eye,” is a common eye condition characterized by inflammation of the tissue surrounding the white part of the eye and inner eyelids. There are two main ways patients may develop this inflammation: an infection or allergic reaction.

There are multiple causes, and therefore multiple ways to manage, conjunctivitis, so it’s important to stay on top of best coding practices. Review these guidelines on the most common CPT^® codes used in managing conjunctivitis, and which codes you should use to code conjunctivitis per the 10^th edition of the ICD-10-CM code set.

Refresh Your Understanding of Conjunctivitis Symptoms and Treatment

While allergic conjunctivitis is not contagious, conjunctivitis associated with a viral or bacterial infection spreads from person to person via contact the infected person’s bodily fluids. Sometimes, improper hygiene with contact lenses can lead to a case of viral or bacterial conjunctivitis. Though less common than infectious or allergic conjunctivitis, people can also develop conjunctivitis if a foreign body gets stuck in their eye. 

Patients with conjunctivitis may experience itching, burning, grittiness, or pain in one or both eyes. Some patients have vision changes or sensitivity to light. Watery eyes or thick mucus discharge from the eye are common.

Viral conjunctivitis, the most common form of the condition, typically resolves on its own within one to two weeks without treatment. However, if the cause is the herpes or Zoster virus, patients may need antiviral eye drops.

Ophthalmologists often treat bacterial conjunctivitis with antibacterial eye drops; providers may also use eye drops in patients with allergic conjunctivitis to ease itching and swelling.

Refer to the B30.- Codes for Viral Conjunctivitis

The 10^th edition of the ICD-10-CM code set lists six codes for viral conjunctivitis:

• B30.0 (Keratoconjunctivitis due to adenovirus)
• B30.1 (Conjunctivitis due to adenovirus)
• B30.2 (Viral pharyngoconjunctivitis)
• B30.3 (Acute epidemic hemorrhagic conjunctivitis (enteroviral))
• B30.8 (Other viral conjunctivitis)
• B30.9 (Viral conjunctivitis, unspecified)

Use the H10.- Codes for Bacterial or Allergic Conjunctivitis

The 10^th edition of the ICD-10-CM code set lists eight codes for bacterial or allergic conjunctivitis:

• H10.0- (Mucopurulent conjunctivitis)
• H10.1- (Acute atopic conjunctivitis)
• H10.2- (Other acute conjunctivitis)
• H10.3- (Unspecified acute conjunctivitis)
• H10.4- (Chronic conjunctivitis)
• H10.5- (Blepharoconjunctivitis)
• H10.8- (Other conjunctivitis)
• H10.9 (Unspecified conjunctivitis)

Know Which CPT^® Codes Are Appropriate for Evaluation and Management of Conjunctivitis

The CPT^® code range 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient) to 92014 (Ophthalmological services … comprehensive, established patient, 1 or more visits) covers general ophthalmological services and procedures. Use 92002 for new patients who receive an intermediate evaluation, diagnosis, and treatment plan; use 92004 (Ophthalmological services … comprehensive, new patient, 1 or more visits) for new patients who receive a comprehensive evaluation, diagnosis, and initiation of treatment.

Similarly, for established patients, use 92012 (Ophthalmological services … intermediate, established patient) for intermediate cases and 92014 for advanced cases. You can determine whether a patient is “established” if any physician who practices in the same specialty and bills under the same group number saw the patient face-to-face within the past 36 months.

Reference These Tips for Coding Conjunctivitis

The H10.- (insert descriptor) codes each have additional characters that offer greater specificity of the diagnosis and indicate which eye is affected.

Example: Under H10.5- (Blepharoconjunctivitis), there is H10.50- (Unspecified blepharoconjunctivitis), H10.51- (Ligneous conjunctivitis), H10.52- (Angular blepharoconjunctivitis), and H10.53- (Contact blepharoconjunctivitis). Use the appropriate 6^th character to indicate which eye is affected: for a patient who has bilateral contact blepharoconjunctivitis, use H10.533 (Contact blepharoconjunctivitis, bilateral).

If you are ever in doubt as to whether a patient’s conjunctivitis is acute, chronic, viral, bacterial, or allergic, ask the provider. Since there is some symptom and presentation overlap between the different types of conjunctivitis, it is important not to make assumptions if you do not have enough information to select an appropriate code.

When coding for viral conjunctivitis, keep in mind:

• The B30.- codes exclude herpesviral ocular disease. Use B00.53 (Herpesviral conjunctivitis) instead for conjunctivitis caused by the herpes virus.
• The B30.- codes exclude ocular Zoster. Use B02.31 (Zoster conjunctivitis) for Zoster conjunctivitis.
• Patients with viral conjunctivitis may have upper respiratory tract infection symptoms.

When coding for bacterial conjunctivitis, it’s important to note:

• If the type of bacteria that caused conjunctivitis is unknown, use an unspecified code. If the bacteria type is known at a subsequent visit, use the appropriate H10.- code.
• Symptoms including discharge (mucus, pus, or watery liquid) may indicate which code is the best fit.
• If a newborn has conjunctivitis due to coming into contact with bacteria during their birth, use P39.1 (Neonatal conjunctivitis and dacryocystitis).

Remember these points when coding for allergic conjunctivitis:

• Most cases of allergic conjunctivitis correspond with one of the H10.1- codes, but there are exceptions.
  • You can use H10.44 (Vernal conjunctivitis) for chronic allergic conjunctivitis in patients reacting to an airborne allergen such as pollen.
  • For patients reacting to other allergens, use H10.45 (Other chronic allergic conjunctivitis).
• Some people refer to allergic conjunctivitis as “red eye.”

Michelle Falci, BA, M Falci Communications LLC, Contributing Writer