PRIMARY CARE SERVICES FOR OCULAR ALLERGY

AH, SPRING. The rebirth of all things planted, spring is a gateway for better things to come — unless you suffer from allergies.

BE INVOLVED & PROACTIVE

Allergic conjunctivitis is common among the general population, estimates range from 6% and 30%, and even more so for individuals with allergic rhinitis, where estimates range from 30% to 71%, according to Current Opinion in Allergy and Clinical Immunology. Hypersensitivity reactions involving the conjunctiva, most commonly seen in our practices, are commonly referred to as allergic conjunctivitis and are further subclassified into seasonal allergic conjunctivitis and perennial allergic conjunctivitis.

However, many patients resort to self-diagnosing and self-treating, often causing greater symptoms, particularly if they are a contact lens wearer. What is the best way to make patients aware that primary eye care providers need to be involved in the diagnosis and treatment of their allergies? The answer is pretty simple: Start telling patients what you do and asking the right questions. The net result will provide the best clinical outcomes and build practices.

With most patients suffering from seasonal allergic conjunctivitis, we know it’s coming, right? Develop assets within the practice or on the website to create awareness among patients that make it clear you are the best professional to diagnose and treat their allergies. You and your staff should be proactive in initiating a dialogue with each patient about ocular allergies and the best contemporary treatment. We must communicate and maintain our role as their doctors to help manage these chronic conditions.

DOCUMENT EVEN IF SIMPLE

Medical coding and compliance requirements for ocular allergy are straightforward and simple; so simple that often O.D.s forget to record their impressions, diagnoses and treatment recommendations in the record and never code or bill for those services.

Keep in mind, you must have a statement either from the patient or as a doctor-directed visit to fulfill the chief complaint requirement. This simply means: Unless the patient comes in with the frank complaint of ocular itching, edema or hyperemia, the visit generally cannot be classified as a medical encounter. However, if you discover signs and symptoms of ocular allergy during a routine annual examination and you initiate or change topical therapy, the subsequent follow-up visit meets the requirement of a doctor-directed visit for a specific reason — and therefore meets the chief complaint requirements as well as those of medical necessity.

CODE WITH PURPOSE

Coding for ocular allergy usually consists of an evaluation and management (E/M) visit code. Most likely, the level of the code is either a 99202/12 or a 99203/13, based on meeting the criterion for each visit.

Often, a 92012 could be appropriate to use as well, provided that you meet the CPT definition of that code – keeping in mind the patient must have a new problem or a complication of an existing condition. Be sure to use the appropriate ICD-10 code; specificity and laterality are key here.

Follow-up evaluations to determine the efficacy of your medical therapy are essential for appropriate long-term management of this chronic condition and are always billed as a separate office visit to the medical carrier. 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.