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  CODING STRATEGY

IDENTIFY OCULAR ALLERGIES

BE PROACTIVE IN DIAGNOSING ALLERGIC CONJUNCTIVITIS

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

WHILE THE wild weather of the past season may still be on our minds, Spring is always a welcome sign of better things to come, that is, unless you are an allergy sufferer. Ocular allergies are a commonplace condition and big business. Individuals who report symptoms of ocular allergy occurs in nearly 40% of the U.S. population, according a study in the October 2010 issue of the Journal of Allergy and Clinical Immunology. That means that 2 out of every 5 patients suffer from these issues. So, why do we ignore it so often?

MY PATIENT NEVER TOLD ME

One of the common excuses I hear from practitioners who are not actively diagnosing and treating ocular allergies is, “The patient never told me about it.” Let’s put this in perspective.

1. It’s most likely a chronic condition that he or she has been dealing with for most of his or her life, so the patient may not mention it to you. And you didn’t ask!

2. He or she doesn’t know your scope of practice and does not know you can help them.

3. The patient is just in for a routine eye exam. (Even if I diagnose it and treat it, I don’t get paid more.)

BE PROACTIVE

Like other chronic conditions we manage, i.e., glaucoma, incorporating the appropriate approach to diagnosis and treating these conditions is critical for our patients’ well-being. We must be proactive in managing our patients’ care both “in” and “out” of season. Patients may choose to self-treat to get relief if they are not made aware of the myriad of treatment protocols available. We must maintain our role as their doctors, through good communication, to help them manage these chronic conditions properly.

To be compliant with respect to the medical record: Define what you have done with the patient and record it accurately. Doing so, allows you to properly receive credit when coding the encounter. Never forget the critical element of the chief complaint to bill a non-refractive encounter. Complaints and symptoms of an eye disease or injury are what I would be looking for here. Unless the patient has complaints of itching, redness, etc., the visit generally will not be classified as medical.

However, during a routine annual exam, if you find signs and symptoms consistent with allergic conjunctivitis and you initiate or change the patient’s therapy (topical, oral or nasal), the subsequent follow-up visit would meet the requirements for a medical carrier to be financially responsible. Generally, this follow-up visit consists of a lower level E/M code, most likely a 99212 or 99213. Occasionally, a 92012 could be appropriate if the CPT definitions and requirements have been met. Be sure to properly map or designate the CPT code to the appropriate current ICD-10 diagnostic code. Also, always evert the lids in your contact lens patients so you can properly diagnose the correct type of allergic conjunctivitis.

PROVIDE THE TREATMENT

Ocular allergy is prevalent condition, but often a forgotten part of primary care that we provide. Be proactive, ask the right questions, listen well and provide the level of care that your patients deserve. OM

DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.