Coding and Billing Ocular Allergies ICD-10

Mar 31, 2021
5 min read
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As we spring into allergy season, ODs will be seeing more and more patients complaining of allergies. Here's what you need to know for billing and coding.

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With spring upon us, you probably have already started to get an uptick of patients with complaints of itchy and watery eyes, redness, and even dryness. Once you determine that the cause is indeed ocular allergies, here are some pointers to help make optometry coding and billing as easy as a spring breeze.

Diagnosis coding for ocular allergies in ICD-10

While your main diagnosis may be allergic conjunctivitis, it is important to remember to be specific and document all of your findings and reported symptoms.

Allergic Conjunctivitis

  • Acute
    • Atopic
      • OD H10.11
      • OS H10.12
      • OU H10.13
    • Follicular
      • OD H10.011
      • OS H10.012
      • OU H10.013
  • Chronic
    • Atopic H10.45
    • Follicular
      • OD H10.431
      • OS H10.432
      • OU H10.433
    • Giant papillary
      • OD H10.411
      • OS H10.412
      • OU H10.413
    • Vernal H10.44

Cornea

  • Punctate Keratitis
    • OD H16.141
    • OS H16.142
    • OU H16.143

Conjunctiva/General

  • Hyperemia
    • OD H11.431
    • OS H11.432
    • OU H11.433
  • Pruritus L29.8
  • Epiphora
    • OD H04.201
    • OS H04.202
    • OU H04.203

Don’t forget that many times what the patient believes to be an ocular manifestation of their allergies may be dry eye symptoms brought on as a side effect to using systemic allergy medications. Since this is affecting the lacrimal glands the following codes would be appropriate.

  • Dry eye symptoms related to lacrimal function
    • OD H04.121
    • OS H04.122
    • OU H04.123

Exam coding for ocular allergies in ICD-10

While coding signs and symptoms may be fairly straightforward, coding the exam itself may be a little more tricky. We will break it down by patients presenting for an annual exam with a secondary complaint of allergy symptoms, and a patient presenting for a medical exam with a primary complaint of allergy symptoms.

Comprehensive exam

The first thing to assess is whether the patient is considered “new” or “established.” According to American Medical Association CPT 2021 Professional Edition, a “new” patient is one who is presenting to the office for the first time OR has not been seen by yourself or another partner in your office for more than 3 years. Next, you will need to decide if you will be requesting the patient to return for a follow-up to monitor or continue treatment of any diagnosis you have made.

  • No follow up required
    • New patient 92002
    • Established patient 92012
  • Follow up required
    • New patient 92004
    • Established patient 92014

Medical exam

The CPT guidelines have been updated for 2021. What do the new changes mean to you? For new and established patient services reported with codes 99202–99215, a clinician may select the code on the basis of time or medical decision-making (MDM).

MDM consists of three elements and two of the three are required.

The elements are:

  • Number and complexity of problems addressed
  • Amount and/or complexity of data to be reviewed and analyzed
  • Risk of complications and/or morbidity or mortality of patient management

New Patients

Note the 99201 code has been eliminated. As you will see, the new codes are based on MDM and time. Previously 99201 required a straightforward MDM as the minimum component. Now that 99202 also requires a straightforward MDM and is the minimum amount of time spent with the patient, so 99201 became redundant.

Code History/Exam MDM Total Minutes
99202 Medically appropriate history and/or examination Straightforward 15-29
99203 Medically appropriate history and/or examination Low 30-44
99204 Medically appropriate history and/or examination Moderate 45-59
99205 Medically appropriate history and/or examination High 60-74

Established Patients

The 99211 code is still available but does not have a time component. It is assumed that the interaction is brief and requires minimal MDM.

Code History/Exam MDM Total Minutes
99212 Medically appropriate history and/or examination Straightforward 10-19
99213 Medically appropriate history and/or examination Low 20-29
99214 Medically appropriate history and/or examination Moderate 30-39
99215 Medically appropriate history and/or examination High 40-54

Two key components to choosing the level of service now are that history and exam don’t count toward the level of service, but ALL time spent caring for the patient on a particular day counts.

You still need to document a medically appropriate history and exam. However, the history may be obtained by staff members and reviewed by the billing practitioner.

What counts for time of patient care?

This includes all time spent on the day of service, including preparing to see the patient, seeing the patient, phone calls or other work done after the visit and documenting in the medical record. Count all of the face-to-face and non–face-to-face time spent by the billing clinician on the day of the visit. This allows you to be compensated when you spend a significant amount of time doing work before or after the visit with the patient. All time must be spent on the day of the patient’s visit, do NOT include any staff time or time spent on any days before or after the visit.

Activities on the day of visit that qualify include:

  • Preparing to see the patient (eg, review of tests)
  • Obtaining and/or reviewing separately obtained history
  • Performing a medically appropriate examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Ordering medications, tests, or procedures
  • Referring and communicating with other healthcare professionals
  • Documenting clinical information in the electronic or other health record
  • Independently interpreting results and communicating results to the patient/family/caregiver
  • Care coordination

These new guidelines allow us to be more fairly compensated for the time it takes for a medical visit, while also taking a lot of the headache and stress out of trying to choose the appropriate code. Hope you have a beautiful spring and your reimbursements bloom with proper coding and billing!

covalentcareers
About Pamela Blade, OD

I am a 2009 graduate of IUSO and have worked coast-to-coast in a variety of practice settings.  I found my niche as an independent contractor with Warby Parker in Orlando, FL. Being on the doorstep to the theme parks, I get to see a wide variety of primary care patients, including world travelers and my local neighbors. I love being active in the community and hearing people say to their family and friends, “That’s my eye doctor!”  I keep it real by being a foster mom for a local pet rescue and indulging my addiction to runDisney events.


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