Coding and Billing

Code Correctly for External Ocular Infections

By Eric Botts, OD

Treating external ocular infections is a practice builder. Coding correctly and processing billing efficiently makes it profitable.

Conjunctivitis, keratitis and blepharitis are treated every day in most busy optometric practices. Knowing how to properly code and bill for these conditions is extremely important if you want to avoid getting behind on your daily schedule of patients. Not knowing correct coding takes additional time to figure it out , and sometimes leads to staffers just throwing their hands up in frustration and not coding at all. For example, consider how easy it is to make the following mistake if your office does not know proper coding for ocular infections:

Correct coding:
Initial office visit for a new patient 99203 or 99204 and follow up visit one day/one week later 99213/92012 with follow up one week/one month later 99212/92012.

Incorrect coding:
Initial office visit for a new patient 99203 or 99204 and follow up visit one day/one week later 99214/92014 with follow up one week/one month later 99214/92014.

ROB Bottom Line:
External Ocular Allergies

Over $100 per patient.

Minimum Five Patients Per Week.

Average initial visit is around $100 per Medicare allowable plus an additional follow-up visit pushes average ocular infection revenues over $500 weekly with five patients per week.

Thus, at a minimum of five patients per week, I generate over $26,000 annually in ocular infection office visits alone. Add in additional procedures like external photos, and the total easily surpasses $32,000 yearly.

Proper Coding Makes Treatment of Ocular Infections a Practice-Builder

Treatment of most external ocular disease is well within the therapeutic level of licensure for all optometrists and is an excellent way to build your practice volume. Treating these conditions ensures that your patients will come to you first whenever they have a red or painful eye. If you properly treat their ocular condition, patients will keep coming back. Lid disease such as blepharitis/meibomianitis has grown my practice income significantly (see blue box to left).

An abundance of ICD-9 diagnosis codes are available for coding ocular infections due to the multitude of different eye infections that we are able to diagnose and treat. The following is a short list of the more common diagnoses:

375.01 Acute Dacryoadenitis
375.02 Chronis Dacryoadenitis
375.32 Acute Dacryocystitis
375.42 Chronic Dacryocystitis

053.21 Herpes Zoster Keratoconjunctivitis
077.1 Epidemic Keratoconjunctivitis
077.3 Adenoviral Conjunctivitis
372.20 Blepharoconjunctivitis, unspecified
372.30 Conjunctivitis, unspecified

053.21 Herpes Zoster Keratoconjunctivitis
054.43 Herpes Simplex Keratitis
370.01 Marginal Corneal Ulcer
370.03 Central Corneal Ulcer
370.21 Punctate Keratitis
370.40 Keratoconjunctivitis, unspecified

379.01 Episcleritis Periodica Fugax
379.03 Anterior Scleritis

372.00 Blepharitis, unspecified
373.11 External Hordeolum
373.12 Internal Hordeolum

CPT codes most frequently used for external ocular infections mainly consist of office visits coded with 99201-99215 or 92002-92014. Additional testing may include 92285 External Ocular Photography and 87809-QW Adenovirus Detection. Note that to use this code, you must have an adenovirus detector and a CLIA waiver from the government. External ocular photography is used to document the disease and educate the patient on treatment success. Adenovirus detection performed in the office using the RPS adeno detector determines whether the infection is caused by an adeno virus as opposed to a bacterial infection. Knowing the cause of the infection makes choosing the correct treatment plan easier.

Laboratory testing like the adeno detector requires a CLIA waiver if you want to be reimbursed by insurances. The CLIA waiver is obtained by submitting an application along with $150 and allows you to perform a limited number of laboratory tests in your office. Reimbursement is minimal and dependent on the insurance carrier.

Corneal edema is often associated with various forms of keratitis and has a list of ICD-9 codes including the following:
371.20 Corneal Edema, unspecified
371.22 Secondary Corneal Edema
371.23 Bullous Keratopathy
371.24 Corneal Edema due to Contact Lens

CPT codes for additional procedures performed to treat corneal edema include:
68761 Lacrimal Punctal Plug
76514 Pachymetry
92025 Corneal Topography
92071 Bandage Contact Lens
92285 External Ocular Photography
92286 Specular Endothelial Microscopy

Reimbursement for these procedures is dependent on your insurance carrier and varies, so it is important to review your EOB (explanation of benefit) to determine which carriers reimburse and what the payment allowables are.

Related ROB Articles

Make the Treatment of Ocular Allergies a Practice Profit Center

Treat for Eye Health–and Code for Profitability

Know Your Billing and Coding: Dry Eye

Eric Botts, OD, is founder and president of OBC Billing Specialists, and president of InnovativeEyes, in Macomb, IL. To contact him:

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