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A patient presents urgently with an eye that is painful, light sensitive and red. He says he was playing basketball with friends. The basketball hit him in the head and he thinks it scratched his eye. So he thought it would be a good idea to come and get it checked out.
This scene plays out in any number of varying presentations in optometric practice, as the underlying diagnosis, corneal abrasion, is a fairly common clinical finding. For many patients, a bandage contact lens is an excellent treatment approach; it can provide protection during the healing process, relieve pain and protect the ocular surface.
While the clinical presentation and treatment regimen may seem straightforward, the coding for it may not be. Let’s break it down to determine how to code the encounter from start to finish, including the diagnosis, initial treatment and follow-up care.
CPT Considerations
When coding with CPT for a corneal abrasion, you will have an office visit to code; in this case either a 920X2 or a 992XX code could be appropriate to use for describing your professional services in examining the patient, determining the primary diagnosis and developing a treatment plan.
Assuming your treatment plan includes applying a soft bandage contact lens, you would use 92071 to describe this service. CPT Code 92071 is defined as: “Fitting of contact lens for treatment of ocular surface disease.”
This code, first appearing in January 2012, does not include the bandage contact lens material—only the service portion of the care provided. You can bill for the bandage lens material as well, provided you are not using a trial lens from your inventory.
You should also keep in mind that for most presentations there is no difficulty in billing both the office visit and the bandage contact lens fit on the same date of service.
In total, the coding for the first encounter, assuming it was the right eye, would be something like this:
CPT Coding
920X2 or 992XX
92071-RT (using the laterality modifier is critical to match your diagnosis)
ICD-10 Specifics
ICD-10 has a slew of codes specific to corneal abrasions and sports-related ocular injuries, and it can be a challenge to know them all. If you were to correctly and completely code the patient example above, it would look like this:
S05.01XA – Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter
W21.05XA – Struck by basketball right eye, initial encounter
Y92.310 – Basketball court as the place of occurrence of the external cause
Y93.67 – Activity, basketball
Many carriers don’t require the W or Y ICD-10 codes, but they are appropriate coding protocol, and you should get in the habit of using them. The seventh character indicates the status of the injury and care. “A” would indicate that this is the initial visit, and the patient is under active management.
Upon follow-up two to three days later (depending on the size of the abrasion) when you remove the bandage lens, simply code an office visit commensurate with the service performed. Without complications, a 992XX code may be the appropriate choice here. With respect to the ICD-10 code, S05.01XD is appropriate, the “D” indicating a subsequent encounter.
Foreign Body Complications
If your encounter involves a foreign body, this changes everything for CPT coding. The Correct Coding Initiative edits only allow billing for the corneal foreign body removal, as an office visit is already included in the surgical procedure code; the bandage contact lens fit is not allowed to be billed on the same day as the minor corneal surgical procedure. You shouldn’t modify your care because of this; you just can’t bill for the office visit unless there are extenuating circumstances and you meet the definition of using a modifier.
The use of soft bandage contact lenses is commonplace in optometric practices. Knowing the rules and compliance issues that affect your medical record keeping and coding is just as essential as the clinical care you provide.
Send your own coding questions and comments to [email protected].
