Providing medical eye care is not only helping many optometrists weather this recession, its actually providing a nice boost to their net incomes these days. And, now that its springtime, its a perfect time to talk about incorporating the diagnosis, treatment and management of ocular allergy into your practice.

Ocular allergy presentation is so common that we often forget the value we provide to both our patients and our practice by treating and prescribing for it. Incorporating the appropriate approach to managing ocular allergy for our patients is critical for both their success and ours as well.

Usually, coding for ocular allergy consists of nothing more than an evaluation and management (E/M) visit code, such as 920X2, 99202 or 99213. In most cases, the allergy sufferer is an established patient, so use 92012, 99212 or 99213. Remember to match the CPT code with an appropriate ICD-9 diagnostic code, and to choose the ICD-9 diagnostic code with the highest level of specificity.


A Typical Allergy Scenario

Patients dont often present to the O.D. with primary ocular allergy as their chief complaint, but rather the diagnosis, treatment and management of ocular allergy are driven by findings in the general refractive examination. Heres a typical scenario:

Step 1. The patient presents for a general refractive examination (920X4) and has ocular allergy symptoms, but those are not the primary reason for the visit. Complete the examination, prescribe any appropriate optical correction and bill the patients refractive carrier (if present) for the comprehensive examination and refraction. If the patient has not been using a prescription ocular medication, write a script for your prescriptive treatment of choice for their ocular allergies. Schedule a one-week follow-up appointment.

Step 2. At the one-week follow-up visit, complete an appropriate history, examination and medical decision-making. Perform acuities and a complete slit lamp examination with lid eversion. Use diagnostic tests to determine if there is an accompanying dry eye component (a common concomitant condition). Be sure to record all components of your history, examination and decision-making in the medical record to support what you did and why you did it (to document medical necessity).

Step 3. Code this follow-up encounter properly (most often 99212, 99213 or 92012), charge the patient for the visit and submit the claim to the patients medical insurance carrier. Bill this visit with a medical diagnosis, utilizing the highest degree of specificity, to the patients medical insurance carrier.

Step 4. Have the patient return for another office visit within six months to monitor allergic signs and symptoms, and to ensure that the patient is using the prescribed medications properly. Double-check the refill schedule to determine if it is appropriate. Code the encounter, charge the patient for the visit and submit the claim to the patients medical insurance carrier.

Step 5. Repeat Step 4 before issuing refills at six-month intervals, and in conjunction with the patients annual comprehensive examination.


Ocular allergies are generally uncomplicated to diagnose and simple to treat, and our patients love us for relieving their symptoms and managing them successfully. Like other chronic conditions, treating ocular allergies also brings an annuity value to your practice as well.

So, be proactive. Dont wait for your patients to complain about their allergies to you (they generally dont even know that you treat ocular allergy). Treat your patients the way they expect you to, write a prescription instead of sampling, incorporate full-scope care into your practice, bill appropriately for your services, and reap the rewards in patient satisfaction and financial well-being for doing so.

Please send your comments to

Clinical Coding Committee

John Rumpakis, O.D., M.B.A., Clinical Coding Editor

Joe DeLoach, O.D.

David Mills, O.D., M.B.A.

Laurie Sorrenson, O.D.
Rebecca Wartman, O.D.

Vol. No: 146:04Issue: 4/15/2009