The importance of accurate coding and contact lens safety
By AOA's Coding Experts Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
While contact lenses are a safe and effective vision correction tool for millions of Americans, appropriate physician oversight is critical.
Over the past few years, new technologies have been introduced that attempt to provide a substitute for an in-person exam and contact lens fitting. There also are new entrants in the market that are attempting to bring these regulated medical devices direct to consumers without an appropriate physician prescription or contact lens fitting. It is important that efforts be made to best understand how these changes are impacting patient safety.
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."
To help with better tracking at the federal level through insurance reporting, it is essential that doctors are appropriately coding patient incidents that are directly 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
Additionally, keratitis should be reported with the H16 code series on the same claim line.
H16.10 Unspecified superficial keratitis
H16.101 ...... right eye
H16.102 ...... left eye
H16.103 ...... bilateral
H16.11 Macular keratitis
H16.111 ...... right eye
H16.112 ...... left eye
H16.113 ...... bilateral
H16.12 Filamentary keratitis
H16.121 ...... right eye
H16.122 ...... left eye
H16.123 ...... bilateral
H16.14 Punctate keratitis
H16.141 ...... right eye
H16.142 ...... left eye
H16.143 ...... bilateral
H16.32 Diffuse interstitial keratitis
H16.321 ....... right eye
H16.322 ........ left eye
H16.323 ------- bilateral
For a complete listing of ICD-10 codes, access the AOA's online coding database, AOA Coding Today.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
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.