Know Your Billing and Coding: Dry Eye

Learn easy billing and coding tips to make dry eye treatment a profitable part of your practice. How often do you hear patients complain about the following: “My eyes are dry,” “My eyes water all the time,” “My eyes feel like there is something gritty in them” or  “My eyes are blurry when I read or work on the computer.” Patients with dry eye symptoms are prevalent in every optometric practice.  In fact, according to the Dry Eye Workshop in 2007, prevalence of dry eye ranges from 5%-30% in people aged 50 years and older.

Long-Term Patients

In many cases, dry eye syndrome (DES) is a chronic eye condition requiring more than the simple recommendation to use OTC artificial tears to relieve symptoms. Often first diagnosed during routine eye exams, DES may often be a chronic eye condition requiring ongoing treatment and frequent follow-up.  Typical DES treatment may include office visits, punctal plug insertion and tear osmolarity testing. Additional tests may include schirmer’s, corneal staining and tear break-up time, however, these are not separately billable procedures but instead included in the office visit.

Typical Treatment Plan–and How to Code for It

A typical patient scenario may look like this:

-Initial office visit 99204/92004 for diagnosis and initiation of therapy and osmolarity test 83861
-One-month follow-up office visit 99213 along with insertion of punctal plugs 68761
-Two-week or one-month follow-up office visit 99213/99212 for punctal occlusion. IMPORTANT: 68761 has a 10-day global period so any visit or procedure associated with DES performed in the 10 days following initial punctal occlusion is included and not allowed to be billed separately.
-Three- to six-month follow-up office visits 99213/99212 to monitor symptoms.

A reminder that the following diagnosis codes support medical necessity for closure of the lacrimal punctum by plug 68761, 370.00-370.07  Corneal ulcer
-370.20-370.21  Superficial keratitis without conjunctivitis
-370.23  Filamentary keratitis
-370.33-370.35  Certain types of keratoconjunctivitis
-371.42   Recurrent corneal erosion
-375.15  Tear film insufficiency
-710.2  Sicca syndrome

Establish Medical Necessity for Punctal Plugs

Also note that most insurance beneficiaries will reimburse for two separate punctum closures 68761 on any given day. As long as medical necessity is documented then closure of two additional punctum may be performed if necessary to alleviate symptoms. In addition to the original short-term collagen plugs, 90-day extend collagen plugs are also available. For patients with year round dry eye symptoms the permanent silicone plugs are most beneficial and may stay in place for long periods of time.

ODs Best Equipped to Treat Dry Eye

Treatment of dry eye patients may vary depending on the severity of symptoms, but remember that DES is a condition affecting millions of people every day and optometrists are in the best position as primary care eye doctors to manage these patients.