the business of contact lenses

Coding Rationale for Corneal Distortion

BY CARLA J. MACK, OD, FAAO

After reading the March 2007 Readers' Forum by Christopher Snyder, OD, MS, FAAO, titled "Hydrogel Lens-related Corneal Distortion," I began to think of the ways that readers might code the two visits described. It's imperative that the practice and practitioners share a coding logic or rationale that they follow consistently and that abides by the parameters provided in the 2007 CPT and ICD-9-CM books.

Dr. Snyder's patient presented with a chief or primary complaint of double vision in the right eye only. If another physician had referred this patient (written or verbal request), consultation coding is appropriate and is generally reimbursed at a higher rate than the equivalent evaluation and management code. Remember, patient self-referrals aren't allowable under the consultation code (99241-99245) guidelines.

Some may code the primary and follow-up visits described with intermediate ophthalmologic service codes (92002, 92012). The medical record must indicate the presence of a new or existing condition, diplopia in this case, with a clearly documented history, general medical observation and external ocular examination.

Alternatively, you could code the visits as evaluation and management visits (992XX) in which accurate recording of the three key components (history, examination and decision making) determines the level. You have the choice to use either one of these sets of codes, but you can't use both for the same visit.

Visit No. 1

My personal coding logic or rationale is to use the evaluation and management code set with additional procedure codes as medically necessary for this case. Without the medical record and detailed visit notes, you can't determine with accuracy the appropriate level of evaluation and management code. However, it appears from Dr. Snyder's case summary that a detailed history, expanded problem-focused examination was performed and low complexity decision making occurred. For this particular case and level of determined key elements, you'd code the visit as a 99202 or 99213 depending on whether the patient was new or established to the practice.

At the first visit, corneal topography was medically necessary and would be coded using CPT 92025. The contact lens fitting of the spherical silicone hydrogel lens would be represented by the CPT code 92310.

If you performed a refraction to assess visual function or to determine power for the new diagnostic lens, you would add CPT 92015. It is possible that four procedures would be necessary to accurately code this visit: refraction, corneal topography, contact lens fitting, and evaluation and management visit.

Diagnosis codes for corneal conditions are represented in the ICD-9-CM from 370.00 to 371.9. Corneal distortion isn't specifically represented in this classification. However, for this case the code 371.82, corneal disorder due to contact lens, represents the corneal distortion caused by hydrogel lens wear. If corneal edema was present, then the better diagnosis code is 371.42, corneal edema due to wearing of contact lenses.

Visit No. 2

Code the one-month follow-up visit using the same logic. Use the complete medical record to determine the appropriate established evaluation and management code. In this case corneal topography was repeated and would be coded again. If you performed a refraction, you would also code and bill at the follow-up visit. I'd keep the diagnosis code of 371.82 and add in the assessment that the condition was resolving. CLS

Dr. Mack is a Diplomate in the Cornea and Contact Lens Section of the American Academy of Optometry and the director of clinics at The Ohio State University College of Optometry.