Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
Has coding got you stumped? Worry no more-the AOA's Coding Experts offer answers to frequently asked questions.
Q. The "Epiphora due to insufficient drainage" ICD-10 diagnosis codes changed? What happened and why?
The ICD-10 code sets are constantly being evaluated. The epiphora due to insufficient drainage codes were revised to eliminate the reference to the lacrimal gland because epiphora due to insufficient drainage does not involve the lacrimal glands; rather, this is a problem of drainage through the puncta, canaliculi or nasolacrimal ducts. The code descriptor was revised for accuracy. The revised codes are below:
- H04.221 Epiphora due to insufficient drainage, right side.
- H04.222 Epiphora due to insufficient drainage, left side.
- H04.223 Epiphora due to insufficient drainage, bilateral.
- H04.229 Epiphora due to insufficient drainage, unspecified side.
Q. Are there really new codes for an MGD diagnosis?
Yes, new codes were developed for MGD. They took effect Oct. 1, 2018. In March 2017, AOA recommended to the ICD-10 Coordination and Maintenance Committee that these codes be developed. For a fully updated listing of diagnosis codes, purchase the 2019 Codes for Optometry manual.
Q. Where can I find the list of codes for which reporting on post-operative visits is required?
Q. I have a new staff member who needs a basic primer regarding coding. Do you have any resources for those new to optometric coding?
Yes, the Back to Basics webinar is available and provides a great intro for coding in the optometric practice.
Q. Do you have any resources on coding related to vision therapy?
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Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.