April 12, 2024 | By: Tammy Welch, CPMA
Eye allergy, also called allergic conjunctivitis, is quite common. They occur when the eyes react to something that irritates them (called an allergen). The eyes produce a substance called histamine to fight off the allergen. As a result, the eyelids, conjunctivitis, and eye allergies do not spread from person to person.
People who have eye allergies commonly have nasal allergies as well, with an itchy, stuffy nose and sneezing. It is usually a temporary condition associated with seasonal allergies.
You can get eye allergies from pet dander, dust, pollen, smoke, perfumes, or even foods. If you cannot avoid the cause, your allergies can be more severe. You can have significant burning and itching and even sensitivity to light.
Diagnosis
To provide proper treatment, your ophthalmologist will check to see if you have an eye infection or allergic conjunctivitis. They can usually diagnose allergic conjunctivitis easily. They will use a slit-lamp microscope to check for signs of eye allergies, such as swollen blood vessels on the surface of the eye. They will talk to you about your medical history and your family’s history of allergies.
Your ophthalmologist may test for a specific type of white blood cell in your eye. They will do this if your allergies are bad or if it is not clear that you have allergic conjunctivitis. They will gently scrape a tiny area of the conjunctiva and test this tissue for those white blood cells.
How are eye allergies treated?
The key to treating eye allergies is to avoid or limit contact with the substance causing the problem. But you must know what to avoid. If necessary, an allergist can perform a skin or blood test to help identify the specific allergen(s).
Artificial Tears
Artificial tear drops help relieve eye allergies temporarily by washing allergens from the eye. They also relieve dry, irritated eyes by adding moisture. You can use these drops, available without a prescription, up to six times a day. You may use them as often as you need to if they are preservative free.
Decongestants (with out without antihistamines)
Decongestants reduce redness in the eyes from allergies. They are available as over-the-counter eye drops.
Exam coding for ocular allergies in ICD-10
While coding signs and symptoms may be fairly straightforward, coding the exam itself may be a little trickier. Breaking down by patient for annual exam with a secondary complaint of allergy symptoms, and a patient presenting for a medical exam with a primary complaint of allergy symptoms.
Comprehensive exam
A comprehensive eye exam must address and assess the complete visual system. The first thing to determine is whether the patient is considered “new” or “established.” According to American Medical Association CPT 2021 Professional Edition, a “new” patient is one who is presenting to the office doe the first time OR has not seen by yourself or another partner in your office for more than 3 years. Next, you will need to decide if you will be requesting the patient to return for a follow-up to monitor or continue treatment of any diagnosis you have made.
Assuming the only reason for a visit is the allergy complaint the most common evaluation and management code choices are
No follow up required
- 92002: New patient medical examination and evaluation with initiation of diagnostic and treatment (intermediate)
- 92012: Established patient medical examination and evaluation with initiation or continuation of diagnostic and treatment (intermediate)
Follow up required
- 92004 New patient medical examination and evaluation with initiation diagnostics and treatment (comprehensive)
- 92012: Established patient medical examination and evaluation with initiation or continuation of diagnostic and treatment (comprehensive)
Assuming the only reason for a visit is the allergy process, the most common evaluation and management code choices are 99203, 99202, 99212 or 99213
- 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making.
- 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
- 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
- 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision-making.
Medical Exam
The CPT guidelines have been updated for 2021. What do the new changes mean to you? For new and established patient services reported with codes 99202-99215, a provider may select the code based on time or medical decision-making. (MDM)
MDM consists of three elements and two of the three are required.
The elements are:
- Number and complexity of problems addressed.
- Amount and/or complexity of data to be reviewed and analyzed.
- Risk of complications and /or morbidity or mortality of patient management.
Tammy Welch, CPMA
