Navigating Glaucoma: Understanding, Facts, and Practical Coding Tips
Glaucoma, often referred to as the "silent thief of sight," affects millions worldwide. Understanding this condition, its implications, and ways to navigate its diagnosis and treatment is crucial.
Here are some essential facts and practical coding tips to aid in managing glaucoma effectively.
Understanding Glaucoma
What is Glaucoma? Glaucoma is a group of eye diseases that damage the optic nerve, leading to vision loss or blindness. It often progresses silently, with no initial symptoms until vision is significantly affected.
Risk Factors: Age, family history, certain ethnicities, and specific medical conditions increase the risk of developing glaucoma.
Detection and Diagnosis: Regular eye exams are vital for early detection. Tests include gonioscopy, visual field testing, and optic nerve imaging.
Treatment: While there's no cure for glaucoma, treatments like eye drops, laser surgery, or conventional surgery can slow its progression and prevent further vision loss.
Practical Coding Tips
ICD-10 Coding: Use specific ICD-10 codes for glaucoma based on type and severity (e.g., Primary Open-Angle Glaucoma - H40.11X).
Check out the Glaucoma Coding Quick Guide from AAO
Example Scenarios:
Staging with Laterality: For instance, H40.2213 signifies severe chronic angle-closure glaucoma in the right eye, with the sixth position indicating right eye involvement (1) and the seventh position denoting severe stage (3).
Staging without Laterality: Take H40.11X3 as an example, representing primary open-angle glaucoma (POAG) in severe stage. In this instance, the X serves as a placeholder, as POAG codes lack laterality indicators.
CPT Coding: Procedures like visual field testing (CPT 92082-92083) have specific codes for reimbursement. Documentation and medical necessity make the difference in billing 92082-92083 as the threshold exam (92083) is typically chosen when there's suspicion of a condition leading to gradual peripheral vision loss, such as glaucoma.
Modifiers: Ensure accurate coding by using modifiers like -LT (left eye) and -RT (right eye) when applicable.
Documentation: Detailed documentation of glaucoma stage, eye affected, severity, and treatment provided is crucial for proper coding and billing.
Stay Updated: Regularly review and update coding practices to align with changes in coding guidelines and regulations.
For Instance, consider the components of the glaucoma screening benefit for Medicare:
When patients phone the office and ask to be screened for glaucoma, staff should confirm the patient meets the criteria, which is any of the following:
People with diabetes mellitus
Persons with a family history of glaucoma
African Americans age 50 and older
Hispanic Americans age 65 and older
Exam elements include:
A dilated eye examination with an intraocular pressure measurement and
A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.
The correct code for reporting is G0117 as a Glaucoma screening for high-risk patients.
ICD-10 CM code Z13.5 Encounters for screening should be used for medical necessity.
Help patients understand that the benefit frequency is every 12 months.
