Medical Coding Training Online — Glaucoma Coding

Medical Coding Training Online — Glaucoma Coding

Alicia: Q: For glaucoma bilateral dif types and dif stages, code each type but highest stage correct? Thanks, Carolyn

A: The fact is that there is a specific role for this. Now, let me just reiterate for some people what glaucoma is because you kind of have to understand what it is to be able to code it correctly. Glaucoma is that sight-threatening disorder. It’s marked by an increased intraocular pressure, or that’s abbreviated IOP. And the pressure which is in the eye that is too high for the optic nerve to tolerate. But to be more specific, I’ve got a little diagram of what it does. But there are two types of glaucoma — we’ll there’re several types of glaucoma but there’s two main types: open angle and closed angle. This is a closed angle view and just to see the detail on this — this was a really good shot and I want to show it to you. The arrow is showing the pressure building up after the cornea.

If you go to the next page, because it shows you open and closed. You do want to note because remember with diabetes, there’s a default with type 2 diabetes because more people have that. This doesn’t have a default but it’s good to note that open angle glaucoma accounts for 90% of all cases because it’s slow and it’s a progressive disease. Whereas, close angle is more of an acute situation; it happens very quickly and it’s very painful. But most people that have glaucoma, it’s open angle.

What you’re seeing there, the drainage in the open angle, see behind the cornea and the iris, all that fluid that is there, that is all pressurized; and if the fluid flow from the back of the eye or the inside of the eye and what is between the cornea and the iris isn’t kept at an even balance pressure builds up. But what happens with the pressure is that, you think, “Well, OK, pressure,” but remember that your eye is pressurized and all the nerves and the blood vessels are so tiny in the eye that if you build up too much pressure it squishes them.

Let’s scroll down to the next page and they show…Here’s an example of normal vision and what people see when they start getting the glaucoma, see how it circles and starts getting darker and darker, and you actually lose that peripheral sight. So, the progression of glaucoma if you look at the optic nerve, see the optic nerve there, the red between the yellow lines and it’s nice and fat and juicy looking. Now, early damage though, if you look, see those lines going top to bottom they’re kind of straight; but in the second early stage one there’s that starts pressing on that optic nerve that the muscles start bowing and there’s a little circle or pocket of fluid that starts to build up and if you could see it’s actually inflamed. See the optic nerve starts getting inflamed. Then, in the severe damage that’s what you see when you look in but see how that optic nerve is pushed out of proportion and there’s a lot of pressure and fluid back there, once you get into severe damage, there’s nothing you can do, you lose your eyesight. So, this is something you need to have checked, and lots of different things cause glaucoma, it’s not something I can put in the slide because it really would take so long.

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