Which codes to use depends on the visit’s circumstances
What code is appropriate for an office visit for allergic conjunctivitis? One of my good friends once said, the most common answer for anything optometry related is “I don’t know,” “It depends” or “Steroids.” Seriously though, this question can have a few different answers. “It depends” applies perfectly here because the code chosen will depend on the exact circumstances of the visit. Let’s run through a few scenarios to demonstrate.
A new patient (one whom hasn’t been seen at your office for three years or more) presents for a comprehensive eye health evaluation. During the course of your visit, he complains of periodic itchy eyes after being around a friend’s cat or dog.
Action step. Determine whether to write him a prescription for an allergy medication to use as needed or to ask the patient to return to the office when the problem occurs for a problem-focused visit and prescription.
Coding. Code this visit based on the chief complaint and history of present illness, for example, for a vision plan requiring 92000 codes, this would be 92004.
→ 92004 ophthalmological services
→ 990 xx
For further information on 99- and 92000 codes, go to https://www.aoa.org/Documents/MORE/Basic-coding-What-OD-need-to-know.pdf .
A new patient (16 years old) complains of itchy, red eyes that have discharge and blurred vision. During the patient history, you determine she has ocular and systemic allergies. (The patient is currently on allergy shots and takes fexofenadine hcl and pseudoephedrine hcl (Allegra-D, Chattem) whenever she has a flare up). She says the medication usually works, but this time her eyes are still red and itchy with discharge for two days now.
Further examination reveals 20/20 vision OD and OS, grade 2 conjunctival papillary reaction, however the rest of the exam (at least eight elements were completed) is unremarkable. The patient is dilated, to be certain all is well with the retina, specifically, because she has never had an eye exam prior to this visit.
Action step. Document the findings listed above in the EHR, and counsel the patient regarding allergic conjunctivitis. Also, prescribe an allergy drop for treatment, and advise a return visit in two weeks.
Coding. You have two options:
The first: a 92004 code (ophthalmological services) defined as: “Medical examination and evaluation with initiation of diagnostic treatment program; comprehensive, new patient, one or more visits.”
The second: a 99000 code. These codes require a specific number of elements for the history, review of systems, past family and social history, as well as examination and medical decision-making to justify the level of coding. What this means is the chart has to follow specific guidelines to justify which 99000 code you choose. Some EHRs will tell you whether you met the level of coding needed for the code chosen, depending on the documentation you recorded in the chart and the level of complexity of the diagnosis you selected. However, the onus is on the doctor to be certain it is correct.
Next time we will discuss a scenario for a patient who presents with multiple problems. OM