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October 2, 2006

Coding for Conjunctivitis
For The Record
Vol. 18 No. 20 P. 61

Conjunctivitis is an inflammation or infection of the thin clear tissue (conjunctiva) that lines the eyelid and part of the eyeball. Also known as pink eye, conjunctivitis may be caused by the following:

• bacteria such as gonorrhea or chlamydia and results in thick, white, creamy discharge;

• virus, which is the most common cause, results in watery or mucous discharge;

• allergens such as pollen, dust, mold, and animal dander;

• incomplete opening of the tear duct in newborns;

• chemical splash; and

• foreign object.

Because conjunctivitis is highly contagious, a person should wash his or her hands often and not touch his or her eye and then touch his or her other eye or another person.

Code Assignments
The AHA Coding Clinic for ICD-9-CM code assignment depends on the type of conjunctivitis documented. Acute conjunctivitis is assigned to subcategory 372.0 with the fifth-digit subclassification as follows:

• 372.00, Acute conjunctivitis, unspecified;

• 372.01, Serous conjunctivitis, except viral—a form characterized by a watery discharge but not due to a virus (includes chemical conjunctivitis);

• 372.02, Acute follicular conjunctivitis;

• 372.03, Other mucopurulent conjunctivitis—includes acute contagious conjunctivitis and angular conjunctivitis;

• 372.04, Pseudomembranous conjunctivitis; and

• 372.05, Acute atopic conjunctivitis—a form caused by an allergen and includes allergic conjunctivitis with hay fever and anaphylactic conjunctivitis.

Other types of acute conjunctivitis include the following:

• 076.0, Trachoma, initial stage—includes acute trachomatous (follicular) conjunctivitis;

• 077.3, Adenoviral conjunctivitis (acute); and

• 077.4, Epidemic hemorrhagic (viral) conjunctivitis—includes acute hemorrhagic (viral) conjunctivitis.

Chronic conjunctivitis is classified to subcategory 372.1 with the fifth-digit subclassification as follows:

• 372.10, Chronic conjunctivitis, unspecified;

• 372.11, Simple chronic conjunctivitis;

• 372.12, Chronic follicular conjunctivitis;

• 372.13, Vernal conjunctivitis;

• 372.14, Other chronic allergic conjunctivitis; and

• 372.15, Parasitic conjunctivitis—code first underlying condition.

Other types of conjunctivitis include the following:

• 032.81, Diphtheritic conjunctivitis;

• 053.21, Herpes zoster conjunctivitis;

• 054.43, Herpes simplex conjunctivitis;

• 077.98, Chlamydial conjunctivitis;

• 095.8 + 372.10, Conjunctivitis due to syphilis; and

• 098.40, Gonococcal conjunctivitis – includes blennorrhagic conjunctivitis.

Viral conjunctivitis is classified to code 077.99 and unspecified conjunctivitis is assigned to code 372.30.

Signs and Symptoms
Common signs and symptoms of conjunctivitis that can affect one or both eyes include the following:

• redness in the whites of the eyes or inner eyelid;

• itchiness;

• blurred vision when discharge temporarily covers the cornea;

• sensitivity to light;

• gritty feeling;

• thick yellow discharge from eyes that can become crusty during the night;

• increased tearing; and

• burning eyes.

Diagnosis
A physician can usually diagnose conjunctivitis based on signs and symptoms. However, the physician may choose to take a sample of the eye secretion to determine the cause of the infection.

Treatment
Treatment for conjunctivitis depends on the type. Conjunctivitis due to bacteria may be treated with antibiotic eyedrops, ointments, or pills. The condition will take several days to clear. Viral conjunctivitis will be treated with over-the-counter medications to relieve symptoms. No other definitive treatment is available other than to let it run its course, which will take four to seven days.

Coding and sequencing for conjunctivitis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

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