Billing Bytes: New Glaucoma Codes

0
256

We are the luckiest people! Sandra Durant CPOC, a certified  Paraoptometric Coder has agreed to do a monthly post for us on Billing and Coding. Sandra has been working in insurance for over 18 years and the past 5.5 in Optometry. She earned her  certification as a CPOC (Certified Paraoptometric Coder) last year and is a member of the AOA’s CPOC Committee in which she assisted in the design of the CPOC exams. Sandra works in Michigan, so some coding might differ due to local or state regulations.

If you have any questions on billing or coding please make a comment below.

Her first post is on New Glaucoma Codes 

As of October 1, 2011, coding for glaucoma became more specific with the additional of new codes and new coding requirements.  Medicare implemented the change effective October 1, 2011 and all other insurance carriers made changes effective January 1, 2012.

There are seven new codes and one revised code in this “glaucoma” category.  The new ICD-9 codes allow differentiating glaucomatous stages into mild, moderate and severe disease.

365.01 – Revised – Open angle with borderline findings, low risk

365.05 – New – Open angle with borderline findings, high risk

365.06 – New – Primary angle closure without glaucoma damage

365.70 – New – Glaucoma stage, unspecified

365.71 – New – Mild stage glaucoma

365.72 – New – Moderate stage glaucoma

365.73 – New – Severe stage glaucoma

365.74 – New – Indeterminate stage glaucoma

Proper coding still requires use of the primary diagnosis to be the disease state, but now the stage of glaucoma should be reported on a second line.  Both diagnoses need to be linked to the CPT code used.

These changes will help prepare doctors for the ICD-10 conversion in October 2013 and are similar in concept to the recent PQRS initiative of reporting “what you find”.  For additional resources, refer to www.aoacodingtoday.com.

Guest Post by Sandra Durant CPOC, a certified  Paraoptometric Coder. Sandra has been working in insurance for over 18 years and the past 5.5 in Optometry. She earned her  certification as a CPOC (Certified Paraoptometric Coder) last year and is a member of the AOA’s CPOC Committee in which she assist in the design of the CPOC exams. 

Feb31 Mid 519