Proper Coding For Dry Eye

Proper Coding For Dry Eye

Medical billing for dry eye syndrome can be pretty complicated. There are several different ways to code for this syndrome. The different methods of medical billing for DES all depend on the documentation and treatment given by the physician.

Dry eye syndrome is when patients have a decrease in their tear gland function. Their tears also begin to evaporate more quickly. If dry eye syndrome goes untreated, it can lead to thickening of the cornea which, in time, will impair vision. When doctors see a patient for this reason, medical billing claims should not be submitted to vision insurance. Vision insurance is for routine eye exams and glasses for routine reasons. The billing should be sent to the medical insurance company since it is a medical diagnosis of the eyes.

Many times insurance companies need further documentation to prove that the condition is medical in nature and not a vision insurance claim. Since this is the case, it is important for medical billing to have proper documentation. This would include: a chief complaint, medical history, what was involved in the exam, findings for diagnostic tests, and a treatment plan. When these elements are submitted with the proper medical billing, it will speed up the reimbursement time.

When coding dry eye evaluation and management visits, the most common CPT code is 9924x. This is the proper medical billing code as long as all the Medicare criteria is followed. This criteria has four elements: request by a physician for a specialist consultation, documentation in medical record the need for consultation, consultant examination, and written report of consultant’s findings to the referring physician.

The most important element of medical billing for dry eye syndrome is documentation of medical condition. Insurance companies are very wary of medical billing claims dealing with the eye. With proper coding and documentation, you will answer all their questions so they can pay the bill as quickly as possible.

View all Articles by: Melissa Clark, CCS-P