Monday, November 13, 2017

What is Respite billing


RESPITE BENEFIT

Respite services provide limited and temporary relief for families caring for beneficiaries with complex health care needs when the care needs require nursing services in lieu of the trained caregivers. Services are provided in the family home by hourly skilled and licensed nursing services as appropriate. To be eligible and authorized for respite, MDHHS must determine the beneficiary to have:

* Health care needs that meet the following criteria:

* That skilled nursing judgments and interventions be provided by licensed nurses in the absence of trained and/or experienced parents/caregivers responsible for the beneficiary’s care;

* That the family situation requires respite; and

* That no other community resources are available for this service.

* No other publicly or privately funded hourly skilled nursing services in the home that would be duplicated by the CSHCS respite benefit.

* Service needs which can reasonably be met only by the CSHCS Respite benefit, not by another service benefit.

Respite is reimbursed when provided by a Medicaid enrolled home health agency, a Medicaid enrolled registered nurse (RN) who is licensed to practice in the state of Michigan, or a Medicaid enrolled licensed practical nurse (LPN) who is licensed to practice in the state of Michigan and working under supervision according to the Michigan Public Health Code. It is the responsibility of the LPN to secure the appropriate supervision and maintain documentation that identifies the supervising professional.

A maximum of 180 hours of CSHCS Respite services may be authorized per family during the 12-montheligibility period. When there is more than one respite-eligible beneficiary in a single home, the respite  service is provided by one nurse at an enhanced reimbursement rate for the services provided to multiple beneficiaries. Allotted respite hours may be used at the discretion of the family within the eligibility period. Unused hours from a particular eligibility period are forfeited at the end of that period and cannot be carried forward into the next eligibility period.

Beneficiaries receiving services through any of the following publicly funded programs and benefits are not eligible for the CSHCS Respite benefit:

* Private Duty Nursing Benefit

* Children’s Waiver

* Habilitation Supports Waiver

* MI Choice Waiver

Requests for respite must be made in writing to MDHHS (refer to the Directory Appendix for contact information) and include
the following information:

* The health care needs of the beneficiary;

* The family situation that influences the need for respite; and

* Other community resources or support systems that are available to the family (e.g., CMH services, MDHHS services, adoption subsidy, SSI, trust funds, etc.).

MDHHS responds to all requests for respite in writing.

Tuesday, October 10, 2017

cpt code for testosterone - j3490, 11980, 84403

CPT/HCPCS Codes

J3490* Testosterone pellets (Testopel®)

11980* Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)

* Providers must bill HCPCS code J3490 and CPT code 11980 on the same claim. If HCPCS code J3490 and CPT code 11980 are not billed on the same claim, the claim will be subject to prepayment review.

TESTOSTERONE CPT CODE: 84403

Covered ICD code for 84403

E89.5 Post procedural testicular hypofunction L63.8 Other alopecia areata
E29.1 Other testicular hypofunction N40.0 Enlarged prostate without LUT symptoms (BPH)
E29.8 Other testicular dysfunction N40.1 Enlarged prostate with LUTS
E34.9 Hormonal imbalance (elevated testosterone)
ICD-10 description: Endocrine disorder unspecified N41.0 Acute prostatitis
F52.22 Female sexual arousal disorder N42.89 Other specified disorders of prostate (Atrophy of prostate)
F52.0 Sexual dysfunctin not due to a substance or known physiological condition (may not be a covered indication for all payers) N46.01 Organic azoospermia
R68.82 Decreased libido N46.11 Organic oligospermia
F52.0 Hypoactive sexual desire disorder N46.029 Infertility due to extratesticular causes
F52.21 Male erectile disorder N52.9 Azoospermia due to other extratesticular causes
F52.31 Female orgasmic disorder L65.9 Alopecia, unspecified
F52.32 Male orgasmic disorder L63.2 Ophiasis
F52.4 Premature ejaculation

Indications and Limitations of Coverage and/or Medical Necessity

Testosterone is an endogenous androgen. Endogenous androgens are responsible for the normal growth and development of the male sex characteristics. Testosterone levels vary from hour to hour; periodic declines below the normal range can occur in some otherwise normal men. An overall diurnal rhythm is also present, the highest levels of circulating testosterone occurring during the early morning hours. In certain medical conditions such as hypogonadism, the endogeonous level of testosterone falls below normal levels. The diagnosis of androgen deficiency is made in men with consistent signs and symptoms and unequivocally low serum testosterone levels. Testosterone levels should be determined in the morning, and studies should be repeated in patients with subnormal levels.

Testosterone pellets (Testopel®) have been approved by the Food and Drug Administration (FDA) for the treatment of primary hypogonadism (congenital or acquired) and hypogonadotrophic hypogonadism (congenital or acquired). Primary hypogonadism includes such conditions as testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testes syndrome; or orchidectomy. Hypogonadotrophic hypogonadism (secondary hypogonadism) includes conditions such as idiopathic or gonadotropic luteinizing hormone releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma or radiation.

Indications:

Testosterone pellets (Testopel®) will be considered medically reasonable and necessary for the following indications:

• Second line testosterone replacement therapy in males with congenital or acquired endogenous androgen absence or deficiency associated with primary or secondary hypogonadism when other standard replacement [intramuscular (IM), buccal, transdermal is not clinically effective; OR,
• For treatment of delayed male puberty

Limitations:

Androgens are contraindicated in men with carcinomas of the breast or with known or suspected carcinomas of the prostate. For patients that clearly meet the indication for testosterone replacement, the reason(s) for a transition to pellets from other effective replacement (IM, buccal, transdermal) must be specifically addressed in the medical record.

Clinical diagnosis of androgen deficiency (non-specific symptoms, low normal testosterone levels, and normal free testosterone) is not a covered indication. Office practices with high utilization of testosterone pellet implantations can be subject to pre- or post-payment review.

Implantable testosterone pellets for the treatment of symptoms associated with menopause is considered not reasonable and necessary as there is insufficient clinical evidence to support this use and is therefore non-covered.



Documentation Requirements

The medical record must substantiate the medical need for testosterone pellets (Testopel®) with documentation of unsuccessful treatments of standard replacement (IM, buccal, transdermal) on more than one occasion, in men with clinically significant symptoms of androgen deficiency.

The reason(s) for a transition to pellets from other effective replacement (IM, buccal, transdermal) must be specifically addressed in the medical record.

The medical record should reflect two total testosterone levels and free testosterone levels when indicated to determine the medical necessity of testosterone replacement. It is suggested to measure morning testosterone level by a reliable assay on two different days. The results of both tests must fall below the normal laboratory reference range. The medical record should include the Clinical Laboratory Improvement Amendments (CLIA) approved reference normal range for the testosterone assay used.

Medical record documentation must be made available upon request. When the documentation does not meet the criteria for the services rendered, or the documentation does not establish the medical necessity for the service(s), such services will be denied as not reasonable and necessary under Section 1862(a)(1) (A) of the Social Security Act.



Testosterone is an endogenous androgen. Endogenous androgens are responsible for the normal growth and development of the male sex characteristics. Testosterone levels vary from hour to hour; periodic declines below the normal range can occur in some otherwise normal men. In certain medical conditions such as hypogonadism, the endogenous level of testosterone falls below normal levels. The diagnosis of androgen deficiency is made in men with consistent signs and symptoms and unequivocally low serum testosterone levels. Testosterone levels should be determined in the morning, and studies should be repeated in patients with subnormal levels.

Testosterone pellets (Testopel®) have been approved by the Food and Drug Administration (FDA) in adult males for the treatment of primary hypogonadism (congenital or acquired) and hypogonadotrophic hypogonadism (congenital or acquired). Primary hypogonadism includes such conditions as testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testes syndrome; or orchidectomy. Hypogonadotrophic hypogonadism (secondary hypogonadism) includes conditions such as idiopathic or gonadotropic luteinizing hormone releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma or radiation. Testopel Pellets are not FDA-approved for administration to females.

Guidelines

Medicare will consider testosterone pellets (Testopel®) medically reasonable and necessary for the following indications:

* Second line testosterone replacement therapy in males with congenital or acquired endogenous androgen absence or deficiency associated with primary or secondary hypogonadism when other standard replacement [intramuscular (IM), buccal, transdermal] is not clinically effective; OR,
* For treatment of delayed male puberty.

Testosterone pellets (Testopel®) method of administration is subcutaneously by a health care professional. 

Limitations

Androgens are contraindicated in men with carcinomas of the breast or with known or suspected carcinomas of the prostate.

For patients that clearly meet the indication for testosterone replacement, the reason(s) for a transition to pellets from other effective replacement (IM, buccal, transdermal) must be specifically addressed in the medical record. Clinical diagnosis of androgen deficiency (non-specific symptoms, low normal testosterone levels, and normal free testosterone) is not a covered indication. Office practices with high utilization of testosterone pellet implantations can be subject to pre- or post-payment review.

Implantable testosterone pellets for the treatment of symptoms associated with menopause is considered not reasonable and necessary as there is insufficient clinical evidence to support this use and is therefore non-covered.


CPT Code Description

11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)


HCPCS Code Description

J3490 Unclassified drugs (Testopel)
S0189 Testosterone pellet, 75 mg (Not recognized by Medicare)


ICD-10 Diagnosis Code Description

C75.1 Malignant neoplasm of pituitary gland
C75.2 Malignant neoplasm of craniopharyngeal duct
D35.2 Benign neoplasm of pituitary gland
D35.3 Benign neoplasm of craniopharyngeal duct
E23.6 Other disorders of pituitary gland
E29.1 Testicular hypofunction
E30.0 Delayed puberty
N44.00 Torsion of testis, unspecified
N44.01 Extravaginal torsion of spermatic cord
N44.02 Intravaginal torsion of spermatic cord


Friday, October 6, 2017

INTERMITTENT NURSING VISITS/AIDE VISITS/THERAPIES Billing Guide

INTERMITTENT NURSING VISITS/AIDE VISITS/THERAPIES

Each visit must be reported on a separate claim line: Medicaid follows Medicare policy on the requirement that each home health agency visit (e.g., nursing, therapy) must be billed on an individual line. This policy includes two visits performed on the same day (i.e., two visits on the same day must be billed on individual lines of the same claim).

Report 15-minute time increments: Medicaid follows Medicare policy for reporting home health visits in 15-minute increments. When billing on the NUBC form, each home health visit revenue code that is reported must have a corresponding 15-minute increment HCPCS code along with the number of15-minute increments reported in the Service Units as follows:

Units Time Requirements

1 1 minute to < 23 minutes

2 23 minutes to < 38 minutes

3 38 minutes to < 53 minutes

4 53 minutes to < 68 minutes

5 68 minutes to < 83 minutes

6 83 minutes to < 98 minutes

7 98 minutes to < 113 minutes

8 113 minutes to < 128 minutes

If services continue for longer periods of time, the home health agency would follow the above pattern. Time of Service Visit: The timing of the visit begins at the beneficiary's home when services actively begin and ends when services are completed. The time counted must be the time spent actively treating the beneficiary. For example:

* If a beneficiary interrupts a treatment to talk on the telephone for other than a minimal amount of time (less than three minutes), then the time the beneficiary spends on the telephone and not engaged in treatment does not count in the amount of service.

* The home health aide completed bathing and transferring the beneficiary into a chair, and now begins to wash the kitchen dishes before leaving. Washing the dishes is considered incidental nd does not meet the definition of a home health aide service. Therefore, the time to perform  this activity would not be included in the 15-minute incremental reporting to Medicaid.


Other nontreatment-related interruptions would follow the same principle. If the beneficiary is late returning home from a doctor’s appointment, the waiting time of the home health agency personnel cannot be counted as treatment time.

However, if the professional spends time with family or other caretakers in the home teaching them to care for the beneficiary, this activity is counted as treatment time. Calls to the physician by the nurse while in the beneficiary’s home to report on the beneficiary’s condition can also be counted as treatment time.

Monday, September 11, 2017

pyelonephritis icd 10 code


N10 Acute tubulo-interstitial nephritis

Includes: acute infectious interstitial nephritis acute pyelitis acute pyelonephritis acute tubular necrosis hemoglobin nephrosis myoglobin nephrosis Use additional code (B95-B97), to identify infectious agent.

N11 Chronic tubulo-interstitial nephritis

Includes: chronic infectious interstitial nephritis chronic pyelitis chronic pyelonephritis Use additional code (B95-B97), to identify infectious agent.

N11.0 Nonobstructive reflux-associated chronic pyelonephritis Pyelonephritis (chronic) associated with (vesicoureteral) reflux

Excludes1: vesicoureteral reflux NOS (N13.70)

N11.1 Chronic obstructive pyelonephritis

Pyelonephritis (chronic) associated with anomaly of pelviureteric junction
Pyelonephritis (chronic) associated with anomaly of pyeloureteric junction
Pyelonephritis (chronic) associated with crossing of vessel
Pyelonephritis (chronic) associated with kinking of ureter
Pyelonephritis (chronic) associated with obstruction of ureter
Pyelonephritis (chronic) associated with stricture of pelviureteric junction
Pyelonephritis (chronic) associated with stricture of ureter
Excludes1: calculous pyelonephritis (N20.9) obstructive uropathy (N13.-)

N11.8 Other chronic tubulo-interstitial nephritis Nonobstructive chronic pyelonephritis NOS

N11.9 Chronic tubulo-interstitial nephritis, unspecified


Chronic interstitial nephritis NOS
Chronic pyelitis NOS
Chronic pyelonephritis NOS

N12 Tubulo-interstitial nephritis, not specified as acute or chronic Includes: interstitial nephritis NOS pyelitis NOS pyelonephritis NOS Excludes1: calculous pyelonephritis (N20.9)

N13 Obstructive and reflux uropathy

Excludes2: calculus of kidney and ureter without hydronephrosis (N20.-) congenital obstructive defects of renal pelvis and ureter (Q62.0-Q62.3) hydronephrosis with ureteropelvic junction obstruction (Q62.1) obstructive pyelonephritis (N11.1)

N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified

Excludes1: Hydronephrosis with ureteral stricture with infection (N13.6)

N13.2 Hydronephrosis with renal and ureteral calculous obstruction Excludes1: Hydronephrosis with renal and ureteral calculous obstruction with infection (N13.6)

N13.3 Other and unspecified hydronephrosis

Excludes1: hydronephrosis with infection (N13.6)

N13.30 Unspecified hydronephrosis

N13.39 Other hydronephrosis

Friday, July 28, 2017

ICD 10 code for conjunctivitis - H10


The most common codes that will be used in Primary Care are related to conjunctivitis. The two categories related to conjunctivitis are found in the table below, but the most commonly used codes are:

• H10.0 Mucopurulent conjunctivitis

• H10.01- Acute follicular conjunctivitis

• H10.02- Other mucopurulent conjunctivitis

• H10.1- Acute atopic conjunctivitis

• H10.2 Other acute conjunctivitis

• H10.21- Acute toxic conjunctivitis

• H10.22- Pseudomembranous conjunctivitis

• H10.23- Serous conjunctivitis, except viral (B30.-)

• H10.3- Unspecified acute conjunctivitis

• H10.4 Chronic conjunctivitis

• H10.40- Unspecified chronic conjunctivitis

• H10.41- Chronic giant papillary conjunctivitis

• H10.42- Simple chronic conjunctivitis

• H10.43- Chronic follicular conjunctivitis

• H10.44 Vernal conjunctivitis

• H10.45 Other chronic allergic conjunctivitis


 Examples:

• Conjunctivitis: H10

• Dry Eye: H04

• Glaucoma: H40

• Retinal Disorders: H33, H34, H35

• First three digits after decimal

• Position 4, or 4 & 5: One or two digits indicating the etiology, or cause, of the condition, e.g., chronic allergic (cause) for conjunctivitis (category).

• Next, one digit that gives location, i.e., which eye:right, left, or bilateral (both).

o While a laterality location code is not required for every diagnosis, we will see it on most eye codes.

o A few codes require location be noted by lid rather than eye.

o Laterality code will be in position 5 or 6,depending upon if there are 1 or 2 digits before denoting cause.


Billing scenario

A patient who is being followed by her Ophthalmologist during the post-op of cataract surgery comes in for an additional visit because she has developed conjunctivitis. The conjunctivitis is unrelated to the cataract surgery and necessitated an additional visit over and above her regular post-op check-ups. The E/M code for the visit is billed to the insurance carrier with a -24 modifier and the diagnosis code used is 372.02 for Acute Conjunctivitis.

Modifier – 24: ICD-10

1. H10.012 Acute conjunctivitis: acute follicular, LEFT eye

2. H26.121 Traumatic cataract: partially resolved RIGHT eye

A54.30 Gonococcal infection, eye, unspecified

A54.31 Gonococcal conjunctivitis

A54.32 Gonococcal iridocyclitis

A54.33 Gonococcal keratitis

A54.39 Gonococcal eye infection, other

H10.***: Conjunctival conditions EyeCodingForum.com 19

H10.011 Acute follicular conjunctivitis, right eye

H10.021 Other mucopurulent conjunctivitis, right eye

H10.11 Acute atopic conjunctivitis, right eye

H10.211 Acute toxic conjunctivitis, right eye

H10.221 Pseudomembranous conjunctivitis, right eye

H10.231 Serous conjunctivitis, except viral, right eye

H10.31 Unspecified acute conjunctivitis, right eye

H10.401 Unspecified chronic conjunctivitis, right eye

H10.***: Conjunctival conditions

• Pingueculitis is an inflammed pinguecula [ H11.151].

H10.411 Chronic giant papillary conjunctivitis (GPC), right eye

H10.421 Simple chronic conjunctivitis, right eye

H10.431 Chronic follicular conjunctivitis, right eye

H10.501 Unspecified blepharoconjunctivitis, right eye

H10.511 Ligneous conjunctivitis, right eye

H10.521 Angular blepharoconjunctivitis, right eye

H10.531 Contact blepharoconjunctivitis, right eye

H10.811 Pingueculitis, right eye



Allergic conjunctivitis is uncomfortable  enough on its own, and the addition of contact lenses tends to further exacerbate the problem. Most of your contact lens wearers will hate the idea of switching back to their glasses for allergy season, so consider some alternatives to making the switch from contacts to glasses.

We see many patients who present to our offi ces with complaints of red eye, or “pink eye,” as they like to call it. Sportscaster Bob Costas came down with a case of it during last month’s 2014 Winter Olympics that made headlines worldwide. While the majority of red eye presentations are caused by various types of conjunctivitis—which is the emphasis of this discussion—it is important to fi rst rule out other possible etiologies prior to initiating treatment for conjunctivitis.  The primary types of conjunctivitis are bacterial, viral, allergic and Chlamydial—with viral and allergic being the most common. A careful evaluation of the patient’s symptoms and clinical signs should enable the practitioner to arrive at a proper diagnosis. 

It is important to fi rst determine  the type of conjunctivitis present before selecting the most appropriate treatment. This depends on the practitioner’s ability to accurately assess the patient’s symptoms and distinguish the clinical signs. Both of these tasks can pose signifi cant challenges for the clinician.

It is usually best to have the patient defi ne itching. For example, ask the patient if the sensation they feel itches like a mosquito bite. Many patients use itching as a broader term and actually may be experiencing a mild scratchiness, which would be more consistent with an infectious process or ocular surface disease, rather than allergic conjunctivitis.  

Another challenge is the overlap of a patient’s symptoms. For example, the chemical mediators released by chronic allergic conjunctivitis may induce a superficial punctate keratitis, which becomes more symptomatic than the original itching complaint. Additionally, keep in mind that itching of the eye itself is the hallmark sign of allergic conjunctivitis. Itching of the eyelids or lid margins may stem from etiologies related to lid disease rather than allergy 

A thorough evaluation of the red eye needs to discern whether the redness is due to hyperemia of the superfi cial conjunctival vessels or injection of the deeper episcleral and/or scleral vessels. Conjunctival hyperemia may indicate an increased permeability of these vessels, leading to the exudative response. Conjunctivitis alone typically does not induce limbal injection. If a determination can not be made solely with slit-lamp observation, the practitioner can always instill a vasoconstrictor and look for blanching of the vessels. Conjunctival vessels will blanch completely, episcleral vessels may partially or totally blanch and scleral vessels will not blanch at all.

Most conjunctivitis cases exhibit an exudative response. Findings may include serous production (i.e., tearing); mucoid, mucopurulent or purulent discharge; fi brinous material or hemorrhage. The serous response may also lead to conjunctival chemosis. Serous discharge or excessive tearing is usually seen with allergic, toxic or viral conjunctivitis, while mucopurulent and/or purulent exudate
is more associated with bacterial and Chlamydial conjunctivitis.

Excessive mucous can be generated  in any type of conjunctivitis, depending upon the severity of the infl ammatory response and irritation to the conjunctival goblet cells. Pseudomembrane formation is due to fi brin in the exudative material; it indicates a higher degree of infl ammation. 

Pseudomembrane material should always be removed, as there is risk of it becoming a true conjunctival membrane. This risk is due to delayed healing of the infl amed tissue secondary to decreased extracellular fi brinolysis. Pseudomembranes are most frequently associated with epidemic keratoconjunctivitis adenoviral disease, but can also be seen with certain bacterial conjunctivitis, such as streptococcal pneumonia or Gonococcus infection. The presence of pseudomembranes always indicates a need for topical steroids as part of the treatment plan. Conjunctival hemorrhages can be seen with any infectious etiology 


Tissue findings in conjunctivitis can manifest as either a papillary or follicular response. Papillae, typically seen in bacterial infection as a response to chronic irritation or allergy, are raised tissue masses found on the palpebral conjunctiva with a central vessel and are created by a focal infi ltration of infl ammatory cells. The type of infl ammatory cell depends on the underlying etiology—for example, eosinophils in allergic conditions vs. neutrophils in bacterial disease. 

Follicles represent expansions of the lymph system with a blisterlike appearance and a central avascular zone with the conjunctival vasculature otherwise following its normal course over the follicle. Follicles are seen in viral, Chlamydial and toxic conditions. In viral conjunctivitis, follicles form in response to viral particles having entered the lymph system, which also creates the localized preauricular lymph node response.

The clinical evaluation of conjunctivitis should also include an assessment of the eyelids, cornea and relevant lymph nodes. Eyelid edema can be seen with any type of conjunctivitis, depending on the severity of the infl ammatory response. While most presentations of conjunctivitis do not affect the cornea, a careful corneal assessment should be performed to rule out any associated punctate keratopathy, dendrites or corneal infi ltrates. Their presence may illuminate a more precise diagnosis or help to better explain patient symptoms. For example, an associated punctate keratopathy may explain the patient’s complaints of a gritty or scratchy feeling. 

The preauricular and submaxillary lymph nodes should always be palpated to rule out enlargement and/or tenderness during a workup for conjunctivitis. Both fi ndings can be associated with viral or Chlamydia infection.

Other cases where laboratory diagnostic testing may be of higher value include suspected MRSA or MRSE infection, chronic conjunctivitis unresponsive to treatment, conjunctivitis potentially secondary to canaliculitis or dacryocystitis, and hyperacute conjunctivitis if Gonococcus is the suspected organism. Minitipped bacterial culturettes are very useful for collecting sample material for laboratory evaluation in these cases.

Most patients report hyperemia, which may be localized, with irritation and stickiness of one eye followed by bilateral involvement in two to three days. Bacterial conjunctivitis frequently presents nasally initially, and then involves the remaining conjunctival surface. A mucopurulent or purulent discharge usually appears within the fi rst 24 hours, which may lead to some patients reporting that the eyelids are matted shut upon awakening in the morning. The sensation of eyelid stickiness or matting is more common in chronic or severe cases. 

• Treatment. Topical antibiotics are the mainstay of bacterial conjunctivitis treatment. Many recent and older antibiotic agents are effective for the treatment of bacterial conjunctivitis. This is important to understand in today’s world of managed care, where formulary restrictions may make it diffi cult or limit the ability to treat with many of the later generation fl uoroquinolone or macrolide agents.

Proper adjunctive treatment of the eyelids is also important in chronic bacterial or lid diseaserelated conjunctivitis. Daily lid hygiene/scrubs should be part of the management plan in these cases and continue on a maintenance basis long term. Lid scrubs with a commercially prepared eyelid cleansing foam or pad product are preferred over baby shampoo for this procedure. Adjunctive treatment with a broad-spectrum oral penicillin or cephalosporin antibiotic, such as amoxicillin/ clavulanate potassium, may be indicated in hyperacute conjunctivitis, chronic conjunctivitis related to lid disease or if associated preseptal cellulitis is suspected. For Neisseria gonorrhoeae-related hyperacute conjunctivitis, one gram of ceftriaxone by IM injection is required.

Proper adjunctive treatment of the eyelids is also important in chronic bacterial or lid diseaserelated conjunctivitis. Daily lid hygiene/scrubs should be part of the management plan in these cases and continue on a maintenance basis long term. Lid scrubs with a commercially prepared eyelid cleansing foam or pad product are preferred over baby shampoo for this procedure. Adjunctive treatment with a broad-spectrum oral penicillin or cephalosporin antibiotic, such as amoxicillin/ clavulanate potassium, may be indicated in hyperacute conjunctivitis, chronic conjunctivitis related to lid disease or if associated preseptal cellulitis is suspected. For Neisseria gonorrhoeae-related hyperacute conjunctivitis, one gram of ceftriaxone by IM injection is required.

EYE

H10.30 Acute Conjunctivitis, Unspecified
H10.429 Chronic Conjunctivitis, Simple
H10.44 Vernal Conjunctivitis
H10.45 Other Chronic Allergic Conjunctivitis
H10.501 Blepharoconjunctivitis, Unspecified, Right Eye
H10.502 Blepharoconjunctivitis, Unspecified, Left Eye
H10.503 Blepharoconjunctivitis, Unspecified, Bilateral
H10.509 Blepharoconjunctivitis, Unspecified

EAR
H60.391 Infective Otitis Externa, Right Ear
H60.392 Infective Otitis Externa, Left Ear
H60.393 Infective Otitis Externa, Unspecified Ear
H60.399 Infective Otitis Externa, Unspecified Ear
H65.00 Acute Serous Otitis Media, Unspecified Ear
H65.01 Acute Serous Otitis Media, Right Ear
H65.02 Acute Serous Otitis Media, Left Ear
H65.03 Acute Serous Otitis Media, Bilateral
H65.119 Acute Allergic Serous Otitis Media
H65.20 Chronic Serous Otitis Media
H65.21 Chronic Serous Otitis Media, Right Ear
H65.22 Chronic Serous Otitis Media, Left Ear
H65.23 Chronic Serous Otitis Media, Bilateral
H65.90 Other and Unspecified Chronic Nonsuppurative Otitis Media.

Unspecified Ear
H65.91 Nonsuppurative Otitis Media, Right Ear
H65.92 Nonsuppurative Otitis Media, Left Ear
H65.93 Nonsuppurative Otitis Media, Bilateral
H66.90 Otitis Media, Unspecified
H66.91 Otitis Media, Right Ear
H66.92 Otitis Media, Left Ear
H66.93 Otitis Media, Bilateral
H69.80 Dysfunction of Eustachian Tube, Unspecified Ear
H69.81 Dysfunction of Eustachian Tube, Left Ear
H69.82 Dysfunction of Eustachian Tube, Right Ear
H69.83 Dysfunction of Eustachian Tube, Bilateral
H83.01 Labyrinthitis, right Ear
H83.02 Labyrinthitis, Left Ear
H83.03 Labyrinthitis, Bilateral
H83.09 Labyrinthitis, Unspecified

Most read cpt modifiers