Diagnosis Coding for Post-LASIK Cataracts

Plus, learn that you should also give credit for time spent with patient

Dx for Post-LASIK Cataracts

Question: A patient who went through LASIK surgery now has cataracts. One of our ophthalmologists carried out topography for calculating the IOL power. The cataract diagnosis (366.16) is not listed as a covered code for that particular diagnostic service. Which ICD-9 coding option should you use for the topography?

Answer: Some payers accept V45.69 (Other states following surgery of eye and adnexa), specifying previous LASIK surgery, as a covered diagnosis for corneal topography. Though, some payers, for instance Cigna, require that V45.69 must be accompanied by ICD-9 coding option 367.22 (Irregular astigmatism). You must check with your payer to see in case it has such limitations.

Corneal topography is an alternate method for deciding IOL power in cases in which earlier LASIK surgery makes it problematic to use an A-scan or IOL Master. Report 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report) for the test.

99214: Give Credit for Time Spent With Patient

Question: Your ophthalmologist spends a lot of time talking about treatment possibilities, imaging results, as well as other issues with patients. How is she ought to document this to support coding E/M based on time?

Answer: While counseling and/or coordination of care take up more than 50 percent of the encounter, and you select to code based on time, CPT®'s E/M ophthalmology coding guidelines tell you "the extent of counseling and/or coordination of care must be documented in the medical record." Medicare's 1995 and 1997 E/M documentation guidelines further add that the physician must document the total length of the encounter, how much of the total time was spent in counseling plus "describe the counseling and/or activities to coordinate care."

Remember: In the office or outpatient setting, you must count only face-to-face time that the physician actually spends with the patient. In the hospital or in a nursing facility, you may count floor/unit time, as per both ophthalmology coding CPT® guidelines and Medicare's documentation guidelines. CPT® guidelines define the encounter as a "physician/patient and/or family encounter."

Example: The physician may document spending 20 minutes of a 25-minute encounter with an established patient talking about test results (she should be specific when documenting the test results) and going over the likely outcome of a procedure. The physician then fills in the remaining details of the visit, as suitable. In this situation, based on the 25-minute session (total time), you should report ophthalmology coding CPT code 99214, which CPT® specifies as usually lasting 25 minutes:

• Office or other outpatient visit for the evaluation and management of an established patient, which needs at least 2 of these 3 key components (A detailed history; A detailed examination; Medical decision making of moderate complexity)
• Counseling and/or coordination of care with other providers or agencies are offered consistent with the nature of the problem(s) and the patient's and/or family's requirements. Generally, the presenting problem(s) are of moderate to high severity. Physicians normally spend 25 minutes face-to-face with the patient and/or family.