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TREAT OSD BEYOND DRY EYE

THE CHIEF COMPLAINT AND HOW YOU TREAT OCULAR SURFACE DISEASE DRIVES THE CODES

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

HAVING A patient return to the office for a “dry eye” workup is a common occurrence in an optometric practice. Ocular surface disease (OSD) is a broad term and a common presentation in our offices. It incorporates not only “dry eye,” but also lid disease and other corneal issues as well. OSD also often occurs with other disease states, such as ocular allergy. Understanding how to determine the accurate type of medical office visit (920XX or 992XX) is essential for proper medical record compliance and patient management. Keep in mind to set expectations for these patients as this is a chronic condition. By most OSD protocols, you will see this patient two to four times per year in addition to those visits for general refractive care.

COMPONENTS GUIDE CODES

When coding for OSD, the first area to consider is the Chief Complaint (CC). The CC must be stated in terms of “complaints or symptoms of an eye disease or injury,” according to the CMS definition, to meet the standard for invoking a patient’s medical insurance benefits. If it is a physician-directed office visit, the CC is implicit if documented correctly: “Patient returning for physician-directed visit secondary to findings consistent with OSD.”

Once the CC requirement has been met, then you can proceed with your evaluation. The level of the office visit must be proportional to the level of the disease state. Codes should be assigned based on the medically necessary individual components that you performed: history, physical exam and medical decision making.

When differentiating between a 920XX code and a 992XX code, remember that a 92012 requires that the patient present with a new condition or an existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis. If that isn’t the case, a 992XX code is the way to go, according to CPT guidelines. I think of the 992XX codes as a “structure and function” based coding hierarchy, rather than the general overall evaluation of a 920XX code. Yes, there is more documentation requirements for a 992XX code, but it is also more precise. In most cases for dry eye, the coding used in the 992XX system would be 99201, 99202, 99212 and 99213. Again, always code each patient encounter by the individual case and the individual patient you are examining and treating.

Most of the additional “tests” you perform will be incidental to the office visit and not separately billable. Things such as measuring tear volume, whether by evaluating the meniscus or by Schirmer, are not separately billable procedures. Clinical lab tests, such as TearLab or InflammaDry, are separately coded and billable, but your practice must be certified with a Clinical Laboratory Improvement Amendments waiver to do these tests. Adjunctive items, such as photos, must have a clear path of medical necessity established in the record to be legitimately performed – and don’t forget the interpretation and report requirement with any special ophthalmic testing.

DO YOUR PART

OSD is a very prevalent condition that affects the quality of life for millions of individuals nationwide. We need to do our part to properly diagnose and manage these patients. 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.