- New Demodex blepharitis codes available for optometrists
- Ask the Coding Experts
- The key to deflecting downcoding? Diagnosis code reporting
- 2025 code changes: What doctors of optometry need to know
- Introducing the new CMS G2211 code
- Coordination of benefits 3 takeaways for optometric billing practices
- Clearing up modifier confusion
- Payor Downcoding: What Is It and What Should You Do About It
- New noteworthy optometry codes
- Modifier -25: How to use it appropriately and avoid costly penalties
- 3 coding questions cracked
- CPT codes deleted in 2023—do you know what codes may be billed to replace them?
- Why Proper Documentation Is Vital
- Common coding questions answered
- How and when to code for social determinants of health
- Most asked coding questions: dilation
- What does COVID-19 PHE ending mean for telemedicine
- 2 points to keep in mind when patients decline dilation
- social determinants of health
- Can a doctor of optometry bill Medicare for a comprehensive eye exam and a procedure on the same day
- The future of audio-only reimbursement
- Coding conundrums solved
- 7 takeaways from the 2023 Medicare Physician Fee Schedule Final Rule
- Virtual check-in codes
- What your colleagues are asking about coding
- CMS releases 2023 Medicare PFS proposed rule
- Merit-based Incentive Payment System: What doctors should know
- Ask the coding experts
- Merit-based Incentive Payment System quality measures
- Coding for presbyopia eye drops
- Coding and contact lens safety
- CMS 2022 Medicare PFS decreases conversion factor sets new policy goals
- CMS releases information on Part B claims-based quality measure scoring for 2021
- Updated ICD-10 codes take effect October 1
- If it sounds too good to be true
- New EM codes
- What to do when a coding decision is made incorrectly
- 4 coding changes now in effect
- changes in 2021 to coding and documentation for evaluation and management services.
- AOA HPI provides coding benchmark data
- Appropriate use of modifier 25
- Changes on the horizon for evaluation and management services
- AOA Coding Experts gain AMA CPT appointments
- 2020 PFS changes for optometry
- 2020 updates to the ICD-10 code set
- Medicares virtual check-in codes
- The importance of accurate coding and contact lens safety
- coding for cognitive development test
- Medicare evaluation and management documentation and billing
- Coding and audits
- 5 coding queries cracked
- Diagnostic code changes
- 4 coding conundrums clarified
- Where coding and coverage intersect
- Changes on the horizon for evaluation and management documentation and reimbursement
- Global period data collection and possible future changes
- New ICD-10 codes effective
- July-Aug17_Coding Q&As
- The ICD 10 code development process
- coding experts-billing for post-cataract glasses
- accurate coding for public health
- July Aug 2017 Coding Experts
- September Coding Experts
- CMS data collection on postoperative visits
- 3 solutions to common coding problems
- 3 coding changes doctors need to know
- Coding cases cracked
- New diabetes related diagnosis codes
- Get answers to your coding questions
- New ICD10 codes doctors need to know
- Be aware of changes for 2017 and beyond
- Common coding Qs answered
- Coverage indications limitations and medical necessity
- 4 tips for competing with online retailers
- Coding questions cracked
- Access online coding resource for AOA members
- What is the future of CPT coding
- CMS makes changes in how doctors revalidate Medicare enrollment information
- 5 coding changes and clarifications doctors need to know
- More ICD 10 coding Q&As
- Doctors of optometry could see a rise in labor costs under new federal overtime rule
- 4 tips for growing your practice
- HHS unveils proposed rule for new Quality Payment Program
- Ask the Coding Experts Comparative billing reports raise questions on glaucoma patient treatment and coding
- Ask the Coding Experts Modifier 24 and 25 usage
- ICD-10 coding QandAs October
- Ask the Coding Experts Chronic care management services
- ICD 10 transition So far so good
- CMS comparative billing reports What you need to know
- Ready resources for the ICD 10 rollout
- Coding Q&As
- Online payment option makes cents
- Modifiers for distinct procedural services
- Get a refresher on your public Open Payments data
- Final countdown Get answers to your ICD-10 coding questions
- AOA clarifies meaningful use rule on electronic order entry
- More ICD 10 coding QandAs
- Vision therapy coding
- Medicare claims and requests for additional documentation
- Coding QnAs May
- Referring ordering and form 8550
- Reporting code 92250
- One-year Medicare payment fix extends ICD-10 deadline
Why appropriate diagnosis code reporting is important
December 27, 2017
Proper coding is necessary for accurate reimbursement.
Excerpted from page 46 of the October 2017 edition of AOA Focus.
When billing insurance companies, oftentimes doctors and their billing support staff will focus foremost on the services provided and the corresponding procedure codes that should be reported. However, it is critical that careful attention is paid to appropriate reporting of diagnosis codes as well.
Diagnosis codes are essential for communicating to insurance companies how sick a patient is, or the complexity of a patient's health history. Ensuring that you are coding a patient's diagnoses appropriately is important for accurate reimbursement.
For ICD-10 diagnosis codes, revisions are made on an annual basis and doctors should ensure they have the latest volume of Codes for Optometry to stay up to date.
On Oct. 1, 2017, many new code changes went into effect for degenerative myopia (H44.2) to allow for greater specificity in reporting.
New codes were added for:
- Degenerative myopia with chorodial neovascularization (H44.2A)
- Degenerative myopia with macular hole (H44.2B)
- Degenerative myopia with retinal detachment (H44.2C)
- Degenerative myopia with foveoschisis (H44.2D)
- Degenerative myopia with other maculopathy (H44.2E)
Additionally, more than 50 new codes were added to the blindness and low vision (H54) code set. These new codes are intended to allow physicians to more accurately capture the vision status of their patients with low vision.
It's also important to note that the World Health Organization's classification of severity of visual impairment was reproduced incorrectly in the ICD-10 code set.
The table below gives a classification of severity of visual impairment recommended by a WHO Study Group on the Prevention of Blindness, Geneva, 6-10 November 1972.
| Visual Acuity with Best Possible Correction |
||
| Category of Visual Impairment | Maximum less than: |
Minimal equal to or better than: |
| 1 | 6/18 3/10 (0.30) 20/70 | 6/60 1/10 (0.10) 20/200 |
| 2 | 6/60 1/10 (0.10) 20/200 | 3/60 1/20 (0.50) 20/400 |
| 3 | 3/60 1/20 (0.50) 20/400 | 1/60 (CF at 1 meter) 1/50 (0.02) 5/300 (20/1200) |
| 4 | 1/60 (CF at 1 meter) 1/50 (0.02) 5/300 | Light Perception |
| 5 | No light Perception | |
| 9 | Undetermined/unspecified | |
CF = central fixation
The term low vision in category H54 comprises categories 1 and 2 of the table; the term blindness, categories 3, 4, and 5; and the term unqualified visual loss, category 9.
If the extent of the visual field is taken into account, patients with a field no greater than 10 degrees but greater than 5 around central fixation should be placed in category 3; patients with a field no greater than 5 around central fixation should be placed in category 4, even if the central acuity is not impaired.