Coding Strabismus – A Look at the ICD-10 Codes

1. Coding Strabismus – A Look at the ICD-10 Codes Read the article to know more about Strabismus (crossed eyes) and its related medical codes that are to be used on medical claims. Strabismus occurs when the eyes appear to be misaligned and point in different directions. In this condition, the eyes do not line up and each eye will focus on a different object. Patients with strabismus have problems with the control of eye movement and cannot keep normal ocular alignment (eye position). One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. The eye turn may be consistent, or it may come and go. Generally, six muscles attach to each eye to control its movement. The muscles receive signals from the brain that direct their movements. In normal cases, the eyes work together so they both point at the same place. However, when problems develop with eye movement control, an eye may turn in, out, up or down. The eye turning may sometimes occur all the time or may appear www.outsourcestrategies.com 918-221-7769

2. only when the person is tired, or has done a lot of reading or close work. In some cases, the same eye may turn each time, whereas in other cases, the eyes may alternate turning. Uncorrected strabismus can have far-reaching effects, including loss of vision and stereoacuity leading to permanently reduced vision in one eye (this condition is called amblyopia or lazy eye) and adverse effects on psychosocial development. Eye specialists treating this condition can rely on reputable medical billing service providers to manage their coding and claim submission processes. Also called crossed eyes, strabismus can occur at any age, but is most common in infants and young children, most often by the age of 3 years. Reports suggest that about 5 percent of all children (both boys and girls equally) in the United States have strabismus. It is estimated that about 1 out of 20 kids has strabismus. However, this condition can also develop among older children and adults and can be caused by a variety of underlying medical conditions such as cerebral palsy or stroke. Types of Strabismus There are different factors that determine the type of strabismus which include – direction and frequency of the eye turn, which eye is affected, extent of the eye turn, sensory issues and cause of eye turn. In most cases, strabismus is classified according to the direction of eye misalignment which include – Esotropia – This is a convergent strabismus where one eye turns inwards towards the nose. Exotropia - This is a divergent strabismus where the one eye turns outwards. Hypertropias and hypotropias - These terms refer to vertical strabismus where one eye is higher (hypertropia) or lower (hypotropia) than the fellow eye. Paralytic strabismus – This type of strabismus is the result of damage to the cranial nerves due to poor blood supply, pressure on the nerve or head injuries causing limited eye movements. Each of the above types of cross eyes consists of different sub-types that carry their own individual characteristics and treatments. www.outsourcestrategies.com 918-221-7769

3. What Causes Strabismus and Related Symptoms? Crossed eyes can occur due to nerve damage or problems with the eye muscles (that surround your eyes) where the signals for vision are processed. When your brain receives a different visual message from each eye, it ignores the signals coming from your weaker eye.The condition is often inherited, with about 30 percent of children with strabismus having a family member with a similar problem. The condition can occur later in life and can be caused by other conditions like - eye injuries, uncorrected refractive errors, poor vision in one eye, diabetes, high blood pressure, cerebral palsy, stroke, Down syndrome and neurological problems. Generally, the condition can occur part of the time (intermittent) or all of the time (constant). Intermittent strabismus may worsen when the eye muscles are tired (for example- late in the day or during an illness). Common signs and symptoms associated with the condition include – Eyes that do not appear to move together Impaired vision Frequent blinking or squinting, especially in bright sunlight Faulty depth perception Eyestrain or headache Eyes that look misaligned Double vision Decreased depth perception Tilting the head to look at things Diagnosing and Treating Strabismus Diagnosis of this eye condition starts with a comprehensive eye exam, with special assessment on how the eyes focus and move. A complete patient history evaluation will be done to determine the symptoms, family history, general health problems and medications being usedthat may be directly contributing to the symptoms. Ophthalmologists may conduct a series of tests to check the internal and external structures of your eyes to rule out any eye disease that may be contributing to strabismus. These include - Corneal light reflex test to check for crossed eyes www.outsourcestrategies.com 918-221-7769

4. Visual acuity test to determine how well you can read from a distance Cover/uncover test to measure your eye movement and deviation Retina exam to examine the backs of your eyes In addition, the ophthalmologist may conduct refraction testing to determine the appropriate lens power a patient needs to compensate for any refractive error (nearsightedness, farsightedness or astigmatism). Treatment plan for crossed eyes will depend on the specific causes and severity of the condition. These include – wearing corrective lenses (such as eyeglasses/contact lenses/prism lenses, vision therapy (a structured program of visual activities to improve eye coordination and eye focusing), orthoptics (eye exercises), medications (eye drops or ointments) and Botox injections (injections to weaken the muscle that’s overacting and causing the eye turn). Eye muscle surgery will be considered as a last option for more severe cases. Surgery changes the length or position of eye muscles so that the eyes are aligned correctly. Ophthalmology medical billing and coding procedure is quite challenging. While treating strabismus, the diagnosis and treatment procedures offered by ophthalmologists must be well- documented by using the correct medical codes. Billing and coding services offered by a reliable medical billing and coding company can help eye specialists use the correct medical codes for their billing purposes. The following ICD-10 diagnosis codes are used for billing procedures – ICD-10 Codes for Strabismus H49 - Paralytic strabismus H50 - Other strabismus H50.0 - Esotropia H50.00 - Unspecified esotropia H50.01 - Monocular esotropia H50.011 - Monocular esotropia, right eye H50.012 - Monocular esotropia, left eye H50.02 - Monocular esotropia with A pattern H50.021 - Monocular esotropia with A pattern, right eye www.outsourcestrategies.com 918-221-7769

5. H50.022 - Monocular esotropia with A pattern, left eye H50.03 - Monocular esotropia with V pattern H50.031 - Monocular esotropia with V pattern, right eye H50.032 - Monocular esotropia with V pattern, left eye H50.04 - Monocular esotropia with other noncomitancies H50.041 - Monocular esotropia with other noncomitancies, right eye H50.042 - Monocular esotropia with other noncomitancies, left eye H50.05 - Alternating esotropia H50.06 - Alternating esotropia with A pattern H50.07 - Alternating esotropia with V pattern H50.08 - Alternating esotropia with other noncomitancies H50.1 - Exotropia H50.10 - Unspecified exotropia H50.11 - Monocular exotropia H50.111 - Monocular exotropia, right eye H50.112 -Monocular exotropia, left eye H50.12 - Monocular exotropia with A pattern H50.121 - Monocular exotropia with A pattern, right eye H50.122 - Monocular exotropia with A pattern, left eye H50.13 - Monocular exotropia with V pattern H50.131 - Monocular exotropia with V pattern, right eye H50.132 - Monocular exotropia with V pattern, left eye H50.14 - Monocular exotropia with other noncomitancies H50.141 - Monocular exotropia with other noncomitancies, right eye H50.142 - Monocular exotropia with other noncomitancies, left eye H50.15 - Alternating exotropia H50.16 - Alternating exotropia with A pattern H50.17 - Alternating exotropia with V pattern H50.18 - Alternating exotropia with other noncomitancies www.outsourcestrategies.com 918-221-7769

6. H50.2 - Vertical strabismus H50.21 - Vertical strabismus, right eye H50.22 - Vertical strabismus, left eye H50.3 - Intermittent heterotropia H50.30 - Unspecified intermittent heterotropia H50.31 - Intermittent monocular esotropia H50.311 - Intermittent monocular esotropia, right eye H50.312 - Intermittent monocular esotropia, left eye H50.32 - Intermittent alternating esotropia H50.33 - Intermittent monocular exotropia H50.331 - Intermittent monocular exotropia, right eye H50.332 - Intermittent monocular exotropia, left eye H50.34 - Intermittent alternating exotropia H50.4 - Other and unspecified heterotropia H50.40 - Unspecified heterotropia H50.41 - Cyclotropia H50.411 - Cyclotropia, right eye H50.412 - Cyclotropia, left eye H50.42 - Monofixation syndrome H50.43 - Accommodative component in esotropia H50.5 - Heterophoria H50.50 - Unspecified heterophoria H50.51 - Esophoria H50.52 - Exophoria H50.53 - Vertical heterophoria H50.54 - Cyclophoria H50.55 - Alternating heterophoria www.outsourcestrategies.com 918-221-7769

7. H50.6 - Mechanical strabismus H50.60 - Mechanical strabismus, unspecified H50.61 - Brown's sheath syndrome H50.611 - Brown's sheath syndrome, right eye H50.612 - Brown's sheath syndrome, left eye H50.69 - Other mechanical strabismus H50.8 - Other specified strabismus H50.81 - Duane's syndrome H50.811 - Duane’s syndrome, right eye H50.812 - Duane's syndrome, left eye H50.89 - Other specified strabismus H50.9 - Unspecified strabismus If strabismus (crossed eyes) is caused by an underlying medical condition, early diagnosis and treatment may help improve your chances of recovery. Seeking the right type of treatment at the right time may lower the risk of suffering complications like – lazy eye (amblyopia), blurry vision, eye strain and double vision. Medical billing and coding requires adequate knowledge about the appropriate codes and payer specific guidelines to ensure correct and on-time reimbursement.However, with the support of a reliable and established medical billing and coding company that offers the services of AAPC- certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission. Outsource Strategies International 8596 E. 101st Street, Suite H Tulsa, OK 74133 www.outsourcestrategies.com 918-221-7769