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H47.321

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H47.321: Drusen of Optic Disc, Right Eye

Clinical Context

** Optic Disc Drusen (ODD)** are globular deposits of calcium and protein salts within the optic nerve head.

  • Significance: They are often visible as “lumpy” yellowish refractile bodies on the disc surface (visible drusen) or buried deep within the nerve (buried drusen).
  • Differential Diagnosis: They are a common cause of Pseudopapilledema (false swelling). Differentiating ODD from true Papilledema (intracranial pressure) is critical.

Note

Symptoms: Often asymptomatic, but can cause transient visual obscurations (TVOs) or progressive peripheral visual field loss.

Coding Distinctions

  • H47.32- represents confirmed Drusen.
  • H47.33- represents Pseudopapilledema (the appearance of swelling, often caused by drusen).
  • Best Practice:* If drusen are confirmed via B-Scan or OCT, code H47.321 rather than just Pseudopapilledema.

ICD-10-CM Diagnosis Codes

Primary Code

  • H47.321** - Drusen of optic disc, right eye
    Usage: Confirmed presence of drusen in the right optic nerve.

** H47.322** - Drusen of optic disc, left eye.
** H47.323** - Drusen of optic disc, bilateral.
** H47.331**- Pseudopapilledema of optic disc, right eye (Use if the drusen causes an elevated appearance, or if the drusen is suspected but not yet confirmed, and the disc looks swollen).

CPT Procedure Codes (Workup)

1 . B-Scan Ultrasonography

Code: 76510

Long Title: Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter.

  • Explanation: The “Gold Standard” for diagnosing buried drusen. Calcium deposits reflect sound waves (hyperechoic) even at low gain settings.
  • wRVU (approx): 0.60 - 0.70
  • Global Period: XXX (Global concept does not apply)
  • Assistant Payable: No

2 . OCT Optic Nerve

Code: 92133

Long Title: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve.

  • Explanation: Visualizes the “lumpy-bumpy” internal structure of the nerve head and measures Retinal Nerve Fiber Layer (RNFL) thickness to monitor for thinning (damage).
  • wRVU (approx): 0.45 - 0.50
  • Global Period: XXX
  • Assistant Payable: No

3 . Visual Field Examination

Code: 92083

Long Title: Visual field examination, unilateral or bilateral, with interpretation and report; extended examination.

  • Explanation: Drusen can compress nerve fibers, causing nasal steps or arcuate defects. Regular fields monitor for progression.
  • wRVU (approx): 0.50
  • Global Period: XXX
  • Assistant Payable: No

Bundling & NCCI Edits

Imaging Bundling


92133 (OCT) vs. 92250 (Fundus Photo)

NCCI edits often bundle 92133 (OCT) and 92250 (Fundus Photography) if performed on the same day.

  • Rule: You usually cannot bill both for the same diagnosis.
  • Exception: If medically necessary for different pathologies (e.g., OCT for Drusen, Photo for a Retinal Nevus), modifier -59 or -XU may be attempted, but payer denial risk is high.

E/M Bundling

  • These diagnostic tests (XXX global) are typically payable in addition to an E/M visit (992xx or 920xx) if the exam is significant and separately identifiable (Modifier -25 is often required by some payers, though technically not required for XXX procedures per Medicare guidelines, many private payers still look for it).

Risk Adjustment (HCC)

  • HCC Category: None.
    • Note: Optic Disc Drusen is considered a structural anomaly and does not map to a CMS-HCC risk category.

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