After the harsh winter we’ve endured, spring is a welcome sign of better and more pleasant things to come.
Unless you’re an allergy sufferer, that is.
In fact, this winter’s huge snowstorms and persistent cold weather could mean a delayed spring bloom, which would result in a higher-than-average pollen count this allergy season.1
In any year, ocular allergy is an extremely common condition, occurring in up to 40% of the US population.2 That means two in every five patients who walk into your practice on any given day suffer from symptoms associated with ocular allergy.
So, what’s the right approach for us to take in order to provide the best clinical outcomes for our patients, while simultaneously growing our practices?
Take a Seasoned Approach
As with other chronic conditions (e.g., glaucoma), incorporating the appropriate approach to managing ocular allergy is critical for both their success and ours. We must be proactive in managing our patients’ care both “in season” and “out of season.” But patients are often unaware of the various treatment protocols that we can offer, and many frequently choose to “self-treat” to get relief. We must communicate and maintain our role as their doctors to help them manage these chronic conditions.
Easy as Scratching an Itch
The medical coding and compliance requirements for allergy may be one of the easiest things that we do; so easy, in fact, that we often neglect to bill the patient for our services because we forget to record the basic elements of this valuable clinical care into our medical record.
Keep in mind that you must have a statement (either from the patient or as a doctor-directed visit) that fulfills the chief complaint requirement, which simply means that unless the patient comes in with a frank complaint of ocular itching, edema or hyperemia, the visit cannot generally be classified as a medical encounter.
However, if you discover signs and symptoms of ocular allergy during a routine annual examination, and you initiate or change topical therapy, the subsequent follow-up visit does meet the requirement of a doctor-directed visit for a specific reason—and therefore meets the chief complaint requirements, as well as those of medical necessity.
Coding for ocular allergy usually consists of nothing more than an evaluation and management (E/M) visit code. Most likely, the level of the code is either a 99202/12 or a 99203/13, based upon meeting the criterion for each visit.
Sometimes, a 92012 could be appropriate to use as well, provided that you meet the CPT definition of that code, and that the patient must have a new problem or a complication of an existing condition.
Remember to match the CPT code with an appropriate current ICD-9 diagnostic code and to choose a diagnosis with the highest level of specificity (five digits). For example, a patient presents with symptoms of ocular itching, stringy discharge or even contact lens discomfort or intolerance. After an appropriate history and pertinent physical examination, your diagnosis is chronic allergic conjunctivitis (372.14), and you’d code your office visit with one of the office visit codes mentioned above.
Follow-up evaluations to determine the efficacy of your medical therapy are essential for appropriate long-term management of this chronic condition, and are always billed as a separate office visit.
Ocular allergy is a prevalent part of the primary care that we provide, and it’s also economically beneficial for our practices. That’s nothing to sneeze at.
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1. Park A. Thanks to the Polar Vortex, Brace Yourself for a Miserable Allergy Season. Time.com. March 26, 2014. Available at: http://time.com/37166/spring-allergies-polar-vortex-winter. Accessed April 1, 2014.
2. Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol. 2010 Oct;126(4):778-83.