Has this ever happened to you? You go to a clinical lecture and hear about a new clinical problem. Then you get back to the office and start to incorporate the new care regimen—but you can’t find the right code to use for billing purposes?

I hear about this dilemma all of the time. So, what can you do?

Let’s take one of the hotter topics in clinical care: meibomian gland dysfunction (MGD) or meibomian gland disease—or whatever name that you want to call it. After the Tear Film & Ocular Surface Society released its 2011 reports about MGD, optometrists across the nation gained a tremendous clinical awareness of this common entity. But, this excitement was quickly followed by a multitude of questions: “What do I bill for expressing the meibomian glands or probing the ducts?” And, “Which tests or instruments do I use for an appropriate (and accurate) diagnosis?”

Well, here’s where reality hits the fan... According to the 2012 ICD-9-CM, there is no such clinical entity for meibomian anything. So, many clinicians have unknowingly been using inaccurate or improper diagnosis codes to describe MGD. Most are improperly using the diagnosis for internal hordeolum (373.12), most likely because someone somewhere told them it is “the code” for meibomitis.

Clarification on Bandage Contact Lenses
Here’s some further clarification regarding information that appeared in the December 2011 column regarding the use of the new CPT code 92071 for bandage contact lens fits.

There is some disparity among carriers whether this code is to be used for fitting of a bandage contact lens at all. Some carriers have indicated that 92071 is an appropriate code for fitting a bandage contact lens and should be used similarly to the now-defunct 92070. But other carriers have interpreted the CPT definition literally and are indicating that 92071 should not be used for that purpose as it is specifically used for fitting a contact lens for the treatment of ocular surface disease (OSD). So what should you do?

First, contact your carriers and find out where they stand on this issue. If they are accepting 92071 as an expanded version of 92070, and they are including corneal abrasion into their definition of OSD, then proceed just as you did with 92070, with the provision that you can now charge for appropriately billable materials in addition to the fitting code. However, if they are restricting use to treat OSD only and corneal abrasion is not included in the more narrow definition, it is recommended that just the office visit be billed without an additional fitting code for the application of the bandage lens.

Clinical lecturers are starting to use descriptive terms like anterior blepharitis or posterior blepharitis. But again, according to the ICD-9 codes, neither of those diagnoses exist, either. You will have to be satisfied with the simple diagnosis of plain old blepharitis (373.0) or unspecified blepharitis (373.00) in such cases.

Likewise, regarding procedure codes, no CPT codes currently exist for expressing the meibomian glands or probing of the glands. The current and proper approach when diagnosing or treating MGD is to simply code the appropriate level of a 992XX code or 920X2 code and nothing more.

There is a HCPCS Level III code for a new device (LipiFlow, TearScience) that is in the marketplace, but this code is only appropriate to use if you possess the instrumentation and are using it according to the definition.

As frustrating as it is, our current coding system isn’t perfect, but it is what we have and are legally bound to use. Please make sure that the medical coding processes that you have in place in your practice are up to date and accurate. This is necessary because we are obligated to accurately describe what we did with the patient and why we did it—and we have to describe it using the diagnosis in the current system that we have.

With efforts by myself and others, perhaps we will see recognition of MGD by the World Health Organization as a valid clinical entity, along with corresponding diagnosis codes, when the upcoming ICD-10 system rolls out in October 2013.