Coding and Billing

Make the Treatment of Ocular Allergies a Practice Profit Center

By Eric Botts, OD

Ocular allergies affect millions of Americans—and you can treat their symptoms. Here’s how to code and bill correctly to make this service a profit center in your practice.

The bad news is that ocular allergies affect a large percentage of your patient population. The good news is that ocular allergies affect a large percentage of your patient population.

Key to Profitability: Pre-Appointing

You can be proactive with your seasonal allergy sufferers and start treatment before symptoms occur by pre-appointing these patients before their allergy season begins. Schedule up to a month prior to their allergy season and begin therapy to minimize their symptoms, and then schedule follow-up visits as needed.  Depending on frequency and severity you may see these patients one to four times or more a year.

Perennial allergy sufferers will present with more chronic symptoms and require follow-up visits. Frequency of follow-up visits will depend on severity of the symptoms and how well your treatment plan is working.

You see allergy sufferers all year round and many do not always schedule their yearly visit during allergy season, so be sure to review every patient health history for a positive response to environmental allergies. Lead the discussion by letting the patient know that you are able to treat their ocular allergy symptoms. Remind them to see you first when their allergies are bothering them or pre-appoint their next visit for preventive allergic conjunctivitis treatment.

If the patient suffers from seasonal allergies, don’t wait until they are experiencing symptoms to see them. If they begin treatment before the allergy season hits them then often the severity and duration of their symptoms may be greatly reduced. This is another excellent opportunity to educate your patient on all the services you can provide them.

Allergic conjunctivitis is an ocular disease that optometrists can diagnose and treat. The best news about this condition is that you do not have to invest in any expensive instrumentation besides your slit lamp to care for these patients. In addition, these patients are loyal to your practice because you are alleviating their allergy symptoms and will continue to return every year because allergic conjunctivitis is typically a chronic condition that returns year after year.

Beyond providing care, here is what you (and your staff) need to know about coding and billing for this treatment.

In the past 12 months, I have seen 247 patients with a diagnosis of ocular allergies. On average, I see them twice a year and charge an office visit each time. Given that many of these patients are established, if I submit the Evaluation & Management CPT code 99213 twice a year for each patient, then at $71 per office visit that equals $35,074 in 12 months.

Diagnosis codes for allergic ocular disease includes the following:
370.32  Limbal and corneal involvement in vernal conjunctivitis
372.05  Acute atopic conjunctivitis
372.13  Vernal conjunctivitis
372.14  Chronic allergic conjunctivitis
373.32  Dermatitis of eyelid, contact and allergic
All of these diagnosis codes are acceptable billing codes for External Ocular Photography 92285 which has an average Medicare allowable of $23 and is a bilateral procedure.  External ocular photography is billable when it is used to measure the progress or deterioration of ocular tissue associated with ocular allergic disease.

Two Major Categories of Allergic Conjunctivitis

Allergic conjunctivitis is divided into two major categories: seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). SAC and PAC are triggered by an immune reaction involving a sensitized individual and an allergen. Ideally, if an individual can pinpoint what they are allergic to and avoid it then their symptoms will be minimal. However, if they are experiencing ocular symptoms they may need the care of their optometrist.

Typical symptoms include:
•    Watery eyes
•    Itchiness
•    Sensitivity to light
•    Redness
•    Grittiness
•    Eyelid swelling

The main difference between SAC and PAC is the timing of the symptoms
Patients with SAC experience symptoms for a short period of time. They may be bothered in the spring by tree pollen, in the summer by grass pollen, or in the fall by weed pollen. Generally, their symptoms resolve during other times of the year, especially in the winter. Patients with PAC experience symptoms throughout the year. Instead of outdoor allergens, they have problems with indoor allergens, such as dust mites and pet dander. Seasonal outdoor allergens may worsen their complaints if they are sensitive to them as well.
If a patient presents with allergic conjunctivitis you should attempt to determine whether it is seasonal or perennial to better decide how often you need to see the patient. A good history of previous episodes or evaluating current symptoms will help you decide.


Eye Allergies guide from eMedicinehealth

Eye Allergy Overview from the American Academy of Allergy Asthma & Immunology

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

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