• Coding Top 10: Silicone Oil Removal, Endothelial Tissue Repositioning and MDF Dystrophy

    Coding Top 10, December 2015

    Ask the Academy Coding Experts is a new online resource for trusted responses to your coding questions.

    The Academy Coding Experts receive daily questions at coding@aao.org and icd10@aao.org. We are committed to providing accurate responses so that practices are confident in their billing and coding practices. We have provided the top 10 questions received for December.

    December's coding questions cover several subspecialties, from cornea to oculofacial, and topics from proper submission of bilateral ocular histoplasmosis to ICD-10 coding for diabetes with macular edema .

    1. ICD-10 code for endothelial tissue repositioning 
      A patient underwent Descemet's stripping automated endothelial keratoplasty (DSAEK) and postoperatively needs an injection of air to reposition the endothelial tissue. What diagnosis should I report?
    2. ICD-10 code for map-dot-frequency dystrophy 
      What ICD-10 code do you recommend for mat-fot-frequency (MDF) dystrophy? I'm told anterior basement membrane dystrophy (ABMD) and MDF are very similar.
    3. Diabetes with macular edema ICD-10 coding 
      When filing a claim to a commercial payer for a patient with diabetes, are we required to bill the diabetes and macular edema separately like ICD-9? If so, which ICD-10 codes should we submit?
    4. Proper submission of bilateral ocular histoplasmosis 
      We have a patient that presented with bilateral ocular histoplasmosis. We submitted claim with B39 as primary and H32 secondary and it was denied stating that are code should be more specific. Are we supposed to submit both diagnoses or is there another code that should be submitted?
    5. ICD-10 equivalent for status post refractive surgery 
      I used ICD-9 code V45.69 for patients who are status post refractive surgery. I am unable to find equivalent ICD-10 code. Is there a specific code I should be using?
    6. Coding for a concussion 
      We have a patient with a history of concussions from football, however no specifics pertaining to these concussions. He has visual field defects and we need to know if we have to code the concussion. If so, how would we code this?
    7. How to properly select the staging for POAG 
      We have a patient with secondary glaucoma due to trauma in her left eye and primary open angle glaucoma (POAG) in her right eye. Do I stage her POAG diagnosis based on her right eye only, or include the left eye as it has a greater visual defect?
    8. ICD-10 code for brow ptosis 
      Can you please provide what ICD-10 code should be used for brow ptosis?
    9. Correct coding for bilateral dermatochalasis 
      When billing for an upper lid blepharoplasty, CPT code 15823, we have always used the -50 modifier to code as bilateral. There isn’t an ICD-10 code for dermatochalasis, bilateral. How do you recommend coding this procedure?
    10. Diagnosis for removal of silicone oil 
      We frequently encounter patients that need to have vitrectomy to remove their silicone oil and are unsure of the appropriate ICD-10 diagnosis code. In ICD-9 we used non-magnetic foreign body in the vitreous. Can you please help?