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Ocular Allergy Codes

The season of “the itch” is upon us.

JOHN RUMPAKIS, O.D., M.B.A.

After what many consider to be one of the worst winters in recent memory, the emergence of sunshine and warm weather brings another season to nearly 50% of the U.S. population: allergy season.

Ocular allergy, experienced by the majority of those who suffer from general seasonal allergies, will soon present itself in our practices on a daily basis.

The diagnosis and treatment of ocular allergy is often the foundation of the therapeutic optometric practice — it is prevalent within the population, and the diagnosis and treatment of the disease are well established. Optometrists often don’t recognize the work they do in the differential diagnosis, clinical tests and medical decision making when treating ocular allergy and often code the professional encounter improperly.

The allergy diagnosis would, at first blush, seem to be easy and straight forward; however, other ocular diseases can masquerade as allergy, and the ocular allergy patient often presents with comorbidities, such as OSD.

One of the best diagnostic tools available is a thorough and accurate patient history. The diagnostic testing required to accurately identify and differentiate allergy from other ocular disease processes is often encompassed within the evaluation and management codes or the general ophthalmic evaluation codes.

Assuming the patient presents with a chief complaint related to ocular allergy, the most common CPT code choices are 92002, 92012, 99202, 99203, 99212 and 99213. Diagnostic tests that might be used in your differential diagnosis might include Schirmer’s test or Phenol Red Thread tear test, tear break-up time, vital dye staining evaluation or slit lamp evaluation with or without lid eversion. These tests are included in the office visit code that is appropriate for the visit complexity and are based upon the medical necessity documented in the medical record. (See “Common ICD-10 Allergy Codes,” below.)

The coding for an allergy patient is not complex, but make sure you base your office visit and clinical tests performed upon the medical necessity of the situation (specific to the patient), and the appropriate diagnosis. Appropriately document any comorbidities that you have diagnosed and are managing, as that can increase the complexity of the medical decision-making component of the E/M codes. OM

DR. RUMPAKIS IS FOUNDER, PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. E-MAIL HIM AT JOHN@PRMI.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.