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|
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.
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.