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Optometry Coding & Billing Alert

Diagnosis Dilemma

The Palmetto auditors looked at whether diagnosis codes were submitted to the highest level of specificity — but in most cases, they fell short.

“We determined that 60 percent of the claims submitted with a diagnosis of glaucoma requiring a stage were not submitted with the additional code,” said Palmetto GBA’s Cyndi Wellborn, RN during the webinar. “Providers should assign as many codes from category H40 (Glaucoma) as necessary to identify the type of glaucoma, the affected eye, and the stage,” she said.

Your documentation should include the stage of glaucoma — if you don’t know it, document that as well, she added. In that case, you’ll use the seventh character of “4” (Indeterminate stage). For instance, H40.1224 (Low-tension glaucoma, left eye, indeterminate stage).