Dry eye is probably the most common ocular complaint you hear. So, take the time to learn both the clinical skills and the medical policies that guide these important therapeutic services.

Most dry eye patients are seen for routine eye care using their vision insurance. But, most vision plans dont reimburse for treating dry eye, so its best to perform evaluation and treatment using the patients major medical insurance. Use any of the eye exam codes (92002 to 92014) or, more commonly, choose the appropriate level evaluation and management (E/M) visit codes (99201 to 99215). Consider 99213 for mild to moderate dry eye evaluation and 99214 for severe or resistant cases.


ICD-9 Codes

The two most commonly used diagnosis codes for dry eye are:

375.15 Tear film insufficiency, unspecified. Use this code only after tear volume tests, such as Schirmers or phenol red thread, demonstrate low tear volume.

370.33 Keratoconjunctivitis sicca, not specified as Sjgrens. The diagnostic linchpin for this code lies in observation of inflammation of conjunctiva and cornea, characterized by horny-looking tissue and excess blood in these areas.

Other diagnostic codes that may be used include:

370.21 Punctate keratitis.

370.34 Exposure keratoconjunctivitis.

710.2 Sjgrens syndrome.

The codes for dry eye are based on clinical findings, not patient symptoms. So, what do you do for a patient who complains of dry eye symptoms yet has no clinical signs? To be consistent with ICD-9 rules, code the symptoms in the absence of a formal diagnosis. These codes include:

379.91 Eye pain. This code may be used for all levels of eye discomfort including the prevalent reports of burning or stinging. 

379.93 Redness of eyes. Be sure to rule out episcleritis (379.01) and scleritis (379.00) before finalizing this code.

375.20 Epiphora. Common in dry eye due to reflex tearing.

Two other special procedure diagnostic codes may also be billed, if justified in the patients record:

92285 External ocular photography. Be sure that the photos document the efficacy of treatment or the progression of the disease, and not just enhance the medical record or billable procedures.

92070 Bandage contact lenses. Use this code to cover both the fitting and supply of therapeutic contacts for dry eye treatment.


Lacrimal Punctal Plugs

Because of many variations in the local coverage determination (LCD) policies of different Medicare and major medical carriers, be sure you thoroughly read your policy on punctal occlusion by plugs (68761) before performing it. Differencessuch as diagnostic work-up, number of puncta occluded and linked diagnostic codesmake it impossible to produce a single, how-to outline for punctal occlusion billing and coding. Still, for most medical carriers, these guidelines apply:

A proper 375.15 dry eye diagnosis is necessary.

Try artificial tear therapy first.

Document evidence of corneal decomposition.

Attempt a trial of collagen plugs. Plug only two puncta first.

If successful, follow with semi-permanent silicone plugs.

Attempt pharmacologic therapy.

Never include dilation of lacrimal punctum (68801) with 68761.

68761 covers both insertion and supply of plugs.

68761 has a 10-day global surgical period during which only issues unrelated to lacrimal occlusion may be billed separately using E/M codes with the -24 modifier.

Many carriers reimburse less for subsequent punctal occlusion procedures due to the CPT characteristics of 68761. Never submit a claim with a reduced fee; let the carrier apply its formula to the full amount submitted.

Next month: coding for IOL post-op comanagement.

Clinical Coding Committee
~John Rumpakis, O.D., M.B.A., Clinical Coding Editor
~D.C. Dean, O.D.
~David Mills, O.D., M.B.A.
~Laurie Sorrenson, O.D.
~Rebecca Wartman, O.D.

Vol. No: 145:02Issue: 2/15/2008