Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D. Excerpted from page 48 of the April 2017 edition of AOA Focus.
In 2014, the Centers for Disease Control and Prevention (CDC) published the report "Estimated Burden of Keratitis—United States, 2010." The report concluded that annually there are nearly 1 million emergency room and urgent doctor visits, and about $175 million is added to health care costs arising from keratitis linked to improper contact lens use.
In the CDC report, it was noted that "the estimated prevalence of visits for keratitis-related diagnostic codes is likely to be an underestimate, because the datasets used in this analysis capture few visits to optometrists." The CDC report also noted that "increased surveillance capacity is needed for microbial keratitis, in particular data from optometrist visits."
Through AOA MORE (Measures and Outcomes Registry for Eyecare), the AOA is working to better capture data on the optometric profession for use in advocacy and research efforts. Having more data to show what we know about the outcomes that doctors of optometry achieve will be a valuable tool for the profession. This type of data collection also can assist in public health awareness and education.
While contact lenses are a safe and effective vision correction tool for millions of Americans, appropriate physician oversight is critical. In a time when some would like to downplay the status of contact lenses as Food and Drug Administration (FDA)-regulated medical devices that require physician oversight, it is critical that agencies such as the CDC have accurate data regarding complications that may occur related to contact lenses.
In order for the data collected by the AOA and other groups to be useful, accurate coding is a must. With regard to contact lens-related complications, it is essential that doctors are appropriately coding patient incidents that are related to contact lens problems. Below is an overview of the diagnosis codes that can be used to accurately report when an eye injury is related to contact lens use:
- H18.211 Corneal edema secondary to contact lens, right eye
- H18.212 Corneal edema secondary to contact lens, left eye
- H18.213 Corneal edema secondary to contact lens, bilateral
- H18.821 Corneal disorder due to contact lens, right eye
- H18.822 Corneal disorder due to contact lens, left eye
- H18.823 Corneal disorder due to contact lens, bilateral
Keratitis should be reported with the H16 code series.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, 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.