Optometry coding: Save 'foggy vision' for Secondary Dx

Optometry coding: Save 'foggy vision' for Secondary Dx

Question: "Many of our patients claim general reasons for their visit such as, "I cannot see well", or "My vision's foggy." We code these visits with 368.8 as the primary diagnosis as this is the primary reason for the visit. Any other problems or underlying causes of the blurry vision, we report as secondary diagnosis. In these situations, is 368.8 the most apt code? Should we list it first?"

Answer: You should only go for 368.8 (Other specified visual disturbances) as a primary diagnosis code when the optometrist does not find a more definitive diagnosis during the course of the visit. Many a time, carriers consider a visit for blurred vision the same thing as a routine exam - and Medicare will not shell out money for this service.

Primary versus secondary: Whenever possible, you should list a more definitive diagnosis as primary and then the patient's complaint of blurred vision as secondary. For instance, if the optometrist finds out that a cataract is causing the patient'sa blurry vision, you'd first go for 366.12 (Incipient cataract) and then 368.8. You should always strive to report the most descriptive and spot on ICD-9 codes possible. If a patient claims her sole reason for the visit is a routine exam, experts recommend that the optometrist ask her a series of detailed questions to uncover any complaints she may have but doesn't think of right away. If she denies any blurriness of vision, the optometrist should query, "Do your eyes ever itch, burn or water?" This may lead you to report dry eye syndrome (375.15, Tear film insufficiency, unspecified) or allergic conjunctivitis (372.14, Other chronic allergic conjunctivitis).

Try this: Rather than ask if a patient's vision is blurry, ask if there's anything she cannot see well enough to do anymore. Older patients sometimes anticipate a loss of vision and will not report something they think is normal. The case history doesn't end until the patient leaves the office; as such sometimes, the true reason for the exam today is determined after the exam is done.

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