GEMS on Steroids by the EyeCodingForum

Transcription

1 GEMS on Steroids by the EyeCodingForum With the looming deadline of October for ICD-10 implementation, there will be hundreds teaching ICD-10 and offering ICD-9 to ICD-10 conversion services. How do you determine who is qualified? How do you distinguish someone who is knowledgeable about ICD-10 coding? And lastly how do you determine is truly knowledgeable about your specialty and can discuss the diseases and diseases on more than a superficial level? Most advise to use the GEMS (General Equivalency Mapping) tool to crosswalk ICD-9 to the correct ICD-10 codes. Some organizations are charging $2500 for this GEMS conversion. The GEMS conversion files are available on the Medicare website but it requires knowledge of database design and manipulation to actually make this work. Plus, as you will see there is a lot of information that is missing from GEMS. Below is a real-world example of converting the top 27 ICD-9 codes from a typical Eyecare clinic to ICD (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 1

2 The Spreadsheet is sorted by rank and shows the ICD-9 code, original description and the ICD-10 crosswalk and GEMS long description. Rank ICD-9 Description ICD10 Long Description Regular Astigmatism H52229 Regular astigmatism, unspecified eye Myopia H5213 Myopia, bilateral Presbyopia H524 Presbyopia Hypermetropia H5203 Hypermetropia, bilateral Senile nuclear sclerosis H2510 Age-related nuclear cataract, unspecified eye Ocular hypertension H40059 Ocular hypertension, unspecified eye Cortical senile cataract H25019 Cortical age-related cataract, unspecified eye Primary open angle glaucoma H4011X3 Primary open-angle glaucoma, severe stage Primary open angle glaucoma H4011X0 Primary open-angle glaucoma, stage unspecified Primary open angle glaucoma H4011X2 Primary open-angle glaucoma, moderate stage Primary open angle glaucoma H4011X4 Primary open-angle glaucoma, indeterminate stage Primary open angle glaucoma H4011X1 Primary open-angle glaucoma, mild stage Blepharitis unspecified H01009 Unspecified blepharitis unspecified eye, unspecified eyelid Benign neoplasm of retina D3120 Benign neoplasm of unspecified retina Acute conjunctivitis unspecified H1033 Unspecified acute conjunctivitis, bilateral Conjunctival hemorrhage H1133 Conjunctival hemorrhage, bilateral Hordeolum externum H00019 Hordeolum externum unspecified eye, unspecified eyelid Diabetes mellitus without complication type II or unspecified type not stated as uncontrolled E119 Type 2 diabetes mellitus without complications Posterior subcapsular polar senile cataract H25049 Posterior subcapsular polar age-related cataract, unspecified eye Tear film insufficiency unspecified H04129 Dry eye syndrome of unspecified lacrimal gland Macular degeneration (senile) of retina unspecified H3530 Unspecified macular degeneration Drusen (degenerative) of retina H35369 Drusen (degenerative) of macula, unspecified eye Preglaucoma unspecified H40009 Preglaucoma, unspecified, unspecified eye Anatomical narrow angle borderline glaucoma H40039 Anatomical narrow angle, unspecified eye Open-angle glaucoma unspecified H4010X3 Unspecified open-angle glaucoma, severe stage Open-angle glaucoma unspecified H4010X0 Unspecified open-angle glaucoma, stage unspecified Open-angle glaucoma unspecified H4010X2 Unspecified open-angle glaucoma, moderate stage Open-angle glaucoma unspecified H4010X4 Unspecified open-angle glaucoma, indeterminate stage Open-angle glaucoma unspecified H4010X1 Unspecified open-angle glaucoma, mild stage Chronic conjunctivitis unspecified H10409 Unspecified chronic conjunctivitis, unspecified eye A list such as this is not enough; there are numerous new concepts, organization, and guidelines that must be taught independent of the actual codes. (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 2

3 While this is a start and gives one an idea of what the new codes look like it is not really usable for several reasons. For one, the names are too long to fit on a fee ticket or cheat sheet so a short, common description is provided below. These are not in GEMS. Rank ICD-9 Description ICD10 Common description Regular Astigmatism H52229 Astigmatism, Regular, unsp eye Myopia H5213 Myopia, bilat Presbyopia H524 Presbyopia Hypermetropia H5203 Hypermetropia, bilat Senile nuclear sclerosis H2510 Cat, a/r nuclear unsp eye Ocular hypertension H40059 hypertension, Ocular unsp eye Cortical senile cataract H25019 Cat, Cortical a/r unsp eye Primary open angle glaucoma H4011X3 Glauc, POAG, sev st Primary open angle glaucoma H4011X0 Glauc, POAG, stage unsp Primary open angle glaucoma H4011X2 Glauc, POAG, mod st Primary open angle glaucoma H4011X4 Glauc, POAG, ind st Primary open angle glaucoma H4011X1 Glauc, POAG, mild stage Blepharitis unspecified H01009 Blepharitis, unsp unsp eye, unsp eyelid Benign neoplasm of retina D3120 Bngn neoplsm Unsp retina Acute conjunctivitis unspecified H1033 Conjunct, unsp acute bilat Conjunctival hemorrhage H1133 Conjunctival hemorrhage, bilat Hordeolum externum H00019 Hordeolum ext unsp eye, unsp eyelid Diabetes mellitus without complication type II or unspecified type not stated as uncontrolled E119 DM T2 w/o complications Posterior subcapsular polar senile cataract H25049 Cat, Post subc polar a/r unsp eye Tear film insufficiency unspecified H04129 Dry eye syndr of unsp lacr gl Macular degeneration (senile) of retina unspecified H3530 Macular degen,unsp Drusen (degenerative) of retina H35369 Drusen (degen) of macula, unsp eye Preglaucoma unspecified H40009 Preglaucoma, unsp, unsp eye Anatomical narrow angle borderline glaucoma H40039 Glauc, Anat narrow/ angle, unsp eye Open-angle glaucoma unspecified H4010X3 Glauc, unsp O-A, sev st Open-angle glaucoma unspecified H4010X0 Glauc, unsp O-A, stage unsp Open-angle glaucoma unspecified H4010X2 Glauc, unsp O-A, mod st Open-angle glaucoma unspecified H4010X4 Glauc, unsp O-A, ind st Open-angle glaucoma unspecified H4010X1 Glauc, unsp O-A, mild stage Chronic conjunctivitis unspecified H10409 Conjunct, unsp chron unsp eye (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 3

4 Also, the order of the diseases needs to be meaningful, like an index, with main term first, and sub-term second. So acute conjunctivitis becomes conjunctivitis, acute. Now we can sort the list by common ICD-10 description. Again, this is not in GEMS. ICD-9 Description ICD10 Common description Regular Astigmatism H52229 Astigmatism, Regular, unsp eye Blepharitis unspecified H01009 Blepharitis, unsp unsp eye, unsp eyelid 2245 Benign neoplasm of retina D3120 Bngn neoplsm Unsp retina Senile nuclear sclerosis H2510 Cat, a/r nuclear unsp eye Cortical senile cataract H25019 Cat, Cortical a/r unsp eye Posterior subcapsular polar senile cataract H25049 Cat, Post subc polar a/r unsp eye Acute conjunctivitis unspecified H1033 Conjunct, unsp acute bilat Chronic conjunctivitis unspecified H10409 Conjunct, unsp chron unsp eye Conjunctival hemorrhage H1133 Conjunctival hemorrhage, bilat Diabetes mellitus without complication type II or unspecified type not stated as E119 DM T2 w/o complications uncontrolled Drusen (degenerative) of retina H35369 Drusen (degen) of macula, unsp eye Tear film insufficiency unspecified H04129 Dry eye syndr of unsp lacr gl Anatomical narrow angle borderline glaucoma H40039 Glauc, Anat narrow/ angle, unsp eye Primary open angle glaucoma H4011X4 Glauc, POAG, ind st Primary open angle glaucoma H4011X1 Glauc, POAG, mild stage Primary open angle glaucoma H4011X2 Glauc, POAG, mod st Primary open angle glaucoma H4011X3 Glauc, POAG, sev st Primary open angle glaucoma H4011X0 Glauc, POAG, stage unsp Open-angle glaucoma unspecified H4010X4 Glauc, unsp O-A, ind st Open-angle glaucoma unspecified H4010X1 Glauc, unsp O-A, mild stage Open-angle glaucoma unspecified H4010X2 Glauc, unsp O-A, mod st Open-angle glaucoma unspecified H4010X3 Glauc, unsp O-A, sev st Open-angle glaucoma unspecified H4010X0 Glauc, unsp O-A, stage unsp Hordeolum externum H00019 Hordeolum ext unsp eye, unsp eyelid 3670 Hypermetropia H5203 Hypermetropia, bilat Ocular hypertension H40059 hypertension, Ocular unsp eye Macular degeneration (senile) of retina unspecified H3530 Macular degen,unsp 3671 Myopia H5213 Myopia, bilat Preglaucoma unspecified H40009 Preglaucoma, unsp, unsp eye 3674 Presbyopia H524 Presbyopia (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 4

5 Our list is much better, but we are not yet done. This list is incomplete as numerous codes expand (and some contract) in ICD-10. Our list of 27 ICD- 9 codes properly expands to 86 ICD-10 codes. Remember that ICD-10 has 69,000 codes compared to 13,000 ICD-9 codes. Note that it is sorted, in a meaningful way, by common name but now the ICD-10 codes are not in order. ICD10 H52223 H52222 H52221 H52229 H01006 H01005 H01004 H01003 H01002 H01001 H01009 H2513 H2512 H2511 H2510 H25013 H25012 H25011 H25019 H25043 H25042 H25041 H25049 H1033 H1032 H1031 H1030 H10403 H10402 Common description Astigmatism, Regular, bilat Astigmatism, Regular, lt eye Astigmatism, Regular, rt eye Astigmatism, Regular, unsp eye Blepharitis, unsp lt eye, unsp eyelid Blepharitis, unsp lt low eyelid Blepharitis, unsp lt up eyeld Blepharitis, unsp rt eye, unsp eyelid Blepharitis, unsp rt low eyelid Blepharitis, unsp rt up eyeld Blepharitis, unsp unsp eye, unsp eyelid Cat, a/r nuclear bilat Cat, a/r nuclear lt eye Cat, a/r nuclear rt eye Cat, a/r nuclear unsp eye Cat, Cortical a/r bilat Cat, Cortical a/r lt eye Cat, Cortical a/r rt eye Cat, Cortical a/r unsp eye Cat, Post subc polar a/r bilat Cat, Post subc polar a/r lt eye Cat, Post subc polar a/r rt eye Cat, Post subc polar a/r unsp eye Conjunct, unsp acute bilat Conjunct, unsp acute lt eye Conjunct, unsp acute rt eye Conjunct, unsp acute unsp eye Conjunct, unsp chron bilat Conjunct, unsp chron lt eye (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 5

6 H10401 H10409 H1133 H1132 H1131 H1130 E119 H35363 H35362 H35361 H35369 H04123 H04122 H04121 H04129 H40033 H40032 H40031 H40039 H4011X4 H4011X1 H4011X2 H4011X3 H4011X0 H4010X4 H4010X1 H4010X2 H4010X3 H4010X0 H00016 H00015 H00014 H00013 Conjunct, unsp chron rt eye Conjunct, unsp chron unsp eye Conjunctival hemorrhage, bilat Conjunctival hemorrhage, lt eye Conjunctival hemorrhage, rt eye Conjunctival hemorrhage, unsp eye DM T2 w/o complications Drusen (degen) of macula, bilat Drusen (degen) of macula, lt eye Drusen (degen) of macula, rt eye Drusen (degen) of macula, unsp eye Dry eye syndr of bilat lacr gl Dry eye syndr of lt lacr gl Dry eye syndr of rt lacr gl Dry eye syndr of unsp lacr gl Glauc, Anat narrow/ angle, bilat Glauc, Anat narrow/ angle, lt eye Glauc, Anat narrow/ angle, rt eye Glauc, Anat narrow/ angle, unsp eye Glauc, POAG, ind st Glauc, POAG, mild stage Glauc, POAG, mod st Glauc, POAG, sev st Glauc, POAG, stage unsp Glauc, unsp O-A, ind st Glauc, unsp O-A, mild stage Glauc, unsp O-A, mod st Glauc, unsp O-A, sev st Glauc, unsp O-A, stage unsp Hordeolum ext lt eye, unsp eyelid Hordeolum ext lt low eyelid Hordeolum ext lt up eyeld Hordeolum ext rt eye, unsp eyelid (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 6

7 H00012 H00011 H00019 H40053 H40052 H40051 H5203 H5202 H5201 H5200 H40059 H3530 H5213 H5212 H5211 H5210 D3122 D3120 D3121 H40003 H40002 H40001 H40009 H524 Hordeolum ext rt low eyelid Hordeolum ext rt up eyeld Hordeolum ext unsp eye, unsp eyelid HTN, Ocular,, bilat HTN, Ocular,, lt eye HTN, Ocular,, rt eye Hypermetropia, bilat Hypermetropia, lt eye Hypermetropia, rt eye Hypermetropia, unsp eye hypertension, Ocular unsp eye Macular degen,unsp Myopia, bilat Myopia, lt eye Myopia, rt eye Myopia, unsp eye neoplsm bngn, lt retina neoplsm, bngn Unsp retina neoplsm, bngn, right retina Preglaucoma, unsp, bilat Preglaucoma, unsp, lt eye Preglaucoma, unsp, rt eye Preglaucoma, unsp, unsp eye Presbyopia (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 7

8 The list below is sorted by ICD-10 code alone but while organized by type and eye part, this is probably not what most clinics will want. ICD-10 Code D3120 D3121 D3122 E119 H00011 H00012 H00013 H00014 H00015 H00016 H00019 H01001 H01002 H01003 H01004 H01005 H01006 H01009 H04121 H04122 H04123 H04129 H1030 H1031 H1032 H1033 H10401 H10402 H10403 H10409 H1130 common description Neoplsm, bngn Unsp retina Neoplsm, bngn, right retina Neoplsm bngn, lt retina DM T2 w/o complications Hordeolum ext rt up eyeld Hordeolum ext rt low eyelid Hordeolum ext rt eye, unsp eyelid Hordeolum ext lt up eyeld Hordeolum ext lt low eyelid Hordeolum ext lt eye, unsp eyelid Hordeolum ext unsp eye, unsp eyelid Blepharitis, unsp rt up eyeld Blepharitis, unsp rt low eyelid Blepharitis, unsp rt eye, unsp eyelid Blepharitis, unsp lt up eyeld Blepharitis, unsp lt low eyelid Blepharitis, unsp lt eye, unsp eyelid Blepharitis, unsp unsp eye, unsp eyelid Dry eye syndr of rt lacr gl Dry eye syndr of lt lacr gl Dry eye syndr of bilat lacr gl Dry eye syndr of unsp lacr gl Conjunct, unsp acute unsp eye Conjunct, unsp acute rt eye Conjunct, unsp acute lt eye Conjunct, unsp acute bilat Conjunct, unsp chron rt eye Conjunct, unsp chron lt eye Conjunct, unsp chron bilat Conjunct, unsp chron unsp eye Conjunctival hemorrhage, unsp eye (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 8

9 H1131 H1132 H1133 H25011 H25012 H25013 H25019 H25041 H25042 H25043 H25049 H2510 H2511 H2512 H2513 H3530 H35361 H35362 H35363 H35369 H40001 H40002 H40003 H40009 H40031 H40032 H40033 H40039 H40051 H40052 H40053 H40059 H4010X0 Conjunctival hemorrhage, rt eye Conjunctival hemorrhage, lt eye Conjunctival hemorrhage, bilat Cat, Cortical a/r rt eye Cat, Cortical a/r lt eye Cat, Cortical a/r bilat Cat, Cortical a/r unsp eye Cat, Post subc polar a/r rt eye Cat, Post subc polar a/r lt eye Cat, Post subc polar a/r bilat Cat, Post subc polar a/r unsp eye Cat, a/r nuclear unsp eye Cat, a/r nuclear rt eye Cat, a/r nuclear lt eye Cat, a/r nuclear bilat Macular degen,unsp Drusen (degen) of macula, rt eye Drusen (degen) of macula, lt eye Drusen (degen) of macula, bilat Drusen (degen) of macula, unsp eye Preglaucoma, unsp, rt eye Preglaucoma, unsp, lt eye Preglaucoma, unsp, bilat Preglaucoma, unsp, unsp eye Glauc, Anat narrow/ angle, rt eye Glauc, Anat narrow/ angle, lt eye Glauc, Anat narrow/ angle, bilat Glauc, Anat narrow/ angle, unsp eye HTN, Ocular,, rt eye HTN, Ocular,, lt eye HTN, Ocular,, bilat hypertension, Ocular unsp eye Glauc, unsp O-A, stage unsp (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 9

10 H4010X1 H4010X2 H4010X3 H4010X4 H4011X0 H4011X1 H4011X2 H4011X3 H4011X4 H5200 H5201 H5202 H5203 H5210 H5211 H5212 H5213 H52221 H52222 H52223 H52229 H524 Glauc, unsp O-A, mild stage Glauc, unsp O-A, mod st Glauc, unsp O-A, sev st Glauc, unsp O-A, ind st Glauc, POAG, stage unsp Glauc, POAG, mild stage Glauc, POAG, mod st Glauc, POAG, sev st Glauc, POAG, ind st Hypermetropia, unsp eye Hypermetropia, rt eye Hypermetropia, lt eye Hypermetropia, bilat Myopia, unsp eye Myopia, rt eye Myopia, lt eye Myopia, bilat Astigmatism, Regular, rt eye Astigmatism, Regular, lt eye Astigmatism, Regular, bilat Astigmatism, Regular, unsp eye Presbyopia (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 10

11 With GEMS on Steroids we now have a meaningful, expanded, sorted alpha list, plus sorted by ICD-10 within each code type below. H52221 H52222 H52223 H52229 H01001 H01002 H01003 H01004 H01005 H01006 H01009 H2510 H2511 H2512 H2513 H25011 H25012 H25013 H25019 H25041 H25042 H25043 H25049 H1030 H1031 H1032 H1033 H10401 H10402 H10403 H10409 H1130 Astigmatism, Regular, rt eye Astigmatism, Regular, lt eye Astigmatism, Regular, bilat Astigmatism, Regular, unsp eye Blepharitis, unsp rt up eyeld Blepharitis, unsp rt low eyelid Blepharitis, unsp rt eye, unsp lid Blepharitis, unsp lt up eyeld Blepharitis, unsp lt low eyelid Blepharitis, unsp lt eye, unsp lid Blepharitis, unsp unsp eye, unsp lid Cat, a/r nuclear unsp eye Cat, a/r nuclear rt eye Cat, a/r nuclear lt eye Cat, a/r nuclear bilat Cat, Cortical a/r rt eye Cat, Cortical a/r lt eye Cat, Cortical a/r bilat Cat, Cortical a/r unsp eye Cat, Post subc polar a/r rt eye Cat, Post subc polar a/r lt eye Cat, Post subc polar a/r bilat Cat, Post subc polar a/r unsp eye Conjunct, unsp acute unsp eye Conjunct, unsp acute rt eye Conjunct, unsp acute lt eye Conjunct, unsp acute bilat Conjunct, unsp chron rt eye Conjunct, unsp chron lt eye Conjunct, unsp chron bilat Conjunct, unsp chron unsp eye Conjunctival hemorrhage, unsp eye (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 11

12 H1131 H1132 H1133 E119 H35361 H35362 H35363 H35369 H04123 H04121 H04122 H04129 H40031 H40032 H40033 H40039 H4011X0 H4011X1 H4011X2 H4011X3 H4011X4 H4010X0 H4010X1 H4010X2 H4010X3 H4010X4 H00011 H00012 H00013 H00014 H00015 H00016 H00019 Conjunctival hemorrhage, rt eye Conjunctival hemorrhage, lt eye Conjunctival hemorrhage, bilat DM T2 w/o complications Drusen (degen) of macula, rt eye Drusen (degen) of macula, lt eye Drusen (degen) of macula, bilat Drusen (degen) of macula, unsp eye Dry eye syndr of bilat lacr gl Dry eye syndr of rt lacr gl Dry eye syndr of lt lacr gl Dry eye syndr of unsp lacr gl Glauc, Anat narrow/ angle, rt eye Glauc, Anat narrow/ angle, lt eye Glauc, Anat narrow/ angle, bilat Glauc, Anat narrow/ angle, unsp eye Glauc, POAG, stage unsp Glauc, POAG, mild stage Glauc, POAG, mod st Glauc, POAG, sev st Glauc, POAG, ind st Glauc, unsp O-A, stage unsp Glauc, unsp O-A, mild stage Glauc, unsp O-A, mod st Glauc, unsp O-A, sev st Glauc, unsp O-A, ind st Hordeolum ext rt up eyeld Hordeolum ext rt low eyelid Hordeolum ext rt eye, unsp lid Hordeolum ext lt up eyeld Hordeolum ext lt low eyelid Hordeolum ext lt eye, unsp lid Hordeolum ext unsp eye, unsp lid (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 12

13 H40051 H40052 H40053 H5200 H5201 H5202 H5203 H40059 H3530 H5210 H5211 H5212 H5213 D3121 D3120 D3122 H40001 H40002 H40003 H40009 H524 HTN, Ocular,, rt eye HTN, Ocular,, lt eye HTN, Ocular,, bilat Hypermetropia, unsp eye Hypermetropia, rt eye Hypermetropia, lt eye Hypermetropia, bilat hypertension, Ocular unsp eye Macular degen,unsp Myopia, unsp eye Myopia, rt eye Myopia, lt eye Myopia, bilat Neoplsm, bngn, right retina Neoplsm, bngn Unsp retina Neoplsm bngn, lt retina Preglaucoma, unsp, rt eye Preglaucoma, unsp, lt eye Preglaucoma, unsp, bilat Preglaucoma, unsp, unsp eye Presbyopia (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 13

14 Below we have all 86 codes on one page. With 9 font and tighter spacing we can fit approximately 150 ICD-10 codes to a full page. H52221 Astigmatism, Regular, rt eye H10403 Conjunct, unsp chron bilat H00011 Hordeolum ext rt up eyeld H52222 Astigmatism, Regular, lt eye H10409 Conjunct, unsp chron unsp eye H00012 Hordeolum ext rt low eyelid H52223 Astigmatism, Regular, bilat H1130 Conjunctival hemorrhage, unsp eye H00013 Hordeolum ext rt eye, unsp lid H52229 Astigmatism, Regular, unsp eye H1131 Conjunctival hemorrhage, rt eye H00014 Hordeolum ext lt up eyeld H01001 Blepharitis, unsp rt up eyeld H1132 Conjunctival hemorrhage, lt eye H00015 Hordeolum ext lt low eyelid H01002 Blepharitis, unsp rt low eyelid H1133 Conjunctival hemorrhage, bilat H00016 Hordeolum ext lt eye, unsp lid H01003 Blepharitis, unsp rt eye, unsp lid E119 DM T2 w/o complications H00019 Hordeolum ext unsp eye, unsp lid H01004 Blepharitis, unsp lt up eyeld H35361 Drusen (degen) of macula, rt eye H40051 HTN, Ocular,, rt eye H01005 Blepharitis, unsp lt low eyelid H35362 Drusen (degen) of macula, lt eye H40052 HTN, Ocular,, lt eye H01006 Blepharitis, unsp lt eye, unsp lid H35363 Drusen (degen) of macula, bilat H40053 HTN, Ocular,, bilat H01009 Blepharitis, unsp unsp eye, unsp lid H35369 Drusen (degen) of macula, unsp eye H5200 Hypermetropia, unsp eye H2510 Cat, a/r nuclear unsp eye H04123 Dry eye syndr of bilat lacr gl H5201 Hypermetropia, rt eye H2511 Cat, a/r nuclear rt eye H04121 Dry eye syndr of rt lacr gl H5202 Hypermetropia, lt eye H2512 Cat, a/r nuclear lt eye H04122 Dry eye syndr of lt lacr gl H5203 Hypermetropia, bilat H2513 Cat, a/r nuclear bilat H04129 Dry eye syndr of unsp lacr gl H40059 hypertension, Ocular unsp eye H25011 Cat, Cortical a/r rt eye H40031 Glauc, Anat narrow/ angle, rt eye H3530 Macular degen,unsp H25012 Cat, Cortical a/r lt eye H40032 Glauc, Anat narrow/ angle, lt eye H5210 Myopia, unsp eye H25013 Cat, Cortical a/r bilat H40033 Glauc, Anat narrow/ angle, bilat H5211 Myopia, rt eye H25019 Cat, Cortical a/r unsp eye H40039 Glauc, Anat narrow/ angle, unsp eye H5212 Myopia, lt eye H25041 Cat, Post subc polar a/r rt eye H4011X0 Glauc, POAG, stage unsp H5213 Myopia, bilat H25042 Cat, Post subc polar a/r lt eye H4011X1 Glauc, POAG, mild stage D3121 Neoplsm, bngn, right retina H25043 Cat, Post subc polar a/r bilat H4011X2 Glauc, POAG, mod st D3120 Neoplsm, bngn Unsp retina H25049 Cat, Post subc polar a/r unsp eye H4011X3 Glauc, POAG, sev st D3122 Neoplsm bngn, lt retina H1030 Conjunct, unsp acute unsp eye H4011X4 Glauc, POAG, ind st H40001 Preglaucoma, unsp, rt eye H1031 Conjunct, unsp acute rt eye H4010X0 Glauc, unsp O-A, stage unsp H40002 Preglaucoma, unsp, lt eye H1032 Conjunct, unsp acute lt eye H4010X1 Glauc, unsp O-A, mild stage H40003 Preglaucoma, unsp, bilat H1033 Conjunct, unsp acute bilat H4010X2 Glauc, unsp O-A, mod st H40009 Preglaucoma, unsp, unsp eye H10401 Conjunct, unsp chron rt eye H4010X3 Glauc, unsp O-A, sev st H524 Presbyopia H10402 Conjunct, unsp chron lt eye H4010X4 Glauc, unsp O-A, ind st (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 14

15 In this version we have added condition types. Many clinics prefer this type organization. After type, the codes are then sorted by properly indexed name, and then by ICD-10 code. None of this is possible with the generic GEMS database. It has to be added manually. In our customized GEMS service the clinic can request a custom sorting by type to match their original fee ticket. Type ICD-10 common description Adnexa H01001 Blepharitis, unsp rt up eyeld Adnexa H01002 Blepharitis, unsp rt low eyelid Adnexa H01003 Blepharitis, unsp rt eye, unsp lid Adnexa H01004 Blepharitis, unsp lt up eyeld Adnexa H01005 Blepharitis, unsp lt low eyelid Adnexa H01006 Blepharitis, unsp lt eye, unsp lid Adnexa H01009 Blepharitis, unsp unsp eye, unsp lid Adnexa H04123 Dry eye syndr of bilat lacr gl Adnexa H04121 Dry eye syndr of rt lacr gl Adnexa H04122 Dry eye syndr of lt lacr gl Adnexa H04129 Dry eye syndr of unsp lacr gl Adnexa H00011 Hordeolum ext rt up eyeld Adnexa H00012 Hordeolum ext rt low eyelid Adnexa H00013 Hordeolum ext rt eye, unsp lid Adnexa H00014 Hordeolum ext lt up eyeld Adnexa H00015 Hordeolum ext lt low eyelid Adnexa H00016 Hordeolum ext lt eye, unsp lid Adnexa H00019 Hordeolum ext unsp eye, unsp lid cataract / lens H2510 Cat, a/r nuclear unsp eye cataract / lens H2511 Cat, a/r nuclear rt eye cataract / lens H2512 Cat, a/r nuclear lt eye cataract / lens H2513 Cat, a/r nuclear bilat cataract / lens H25011 Cat, Cortical a/r rt eye cataract / lens H25012 Cat, Cortical a/r lt eye cataract / lens H25013 Cat, Cortical a/r bilat cataract / lens H25019 Cat, Cortical a/r unsp eye cataract / lens H25041 Cat, Post subc polar a/r rt eye cataract / lens H25042 Cat, Post subc polar a/r lt eye cataract / lens H25043 Cat, Post subc polar a/r bilat (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 15

16 cataract / lens H25049 Cat, Post subc polar a/r unsp eye Conjunctiva H1030 Conjunct, unsp acute unsp eye Conjunctiva H1031 Conjunct, unsp acute rt eye Conjunctiva H1032 Conjunct, unsp acute lt eye Conjunctiva H1033 Conjunct, unsp acute bilat Conjunctiva H10401 Conjunct, unsp chron rt eye Conjunctiva H10402 Conjunct, unsp chron lt eye Conjunctiva H10403 Conjunct, unsp chron bilat Conjunctiva H10409 Conjunct, unsp chron unsp eye Conjunctiva H1130 Conjunctival hemorrhage, unsp eye Conjunctiva H1131 Conjunctival hemorrhage, rt eye Conjunctiva H1132 Conjunctival hemorrhage, lt eye Conjunctiva H1133 Conjunctival hemorrhage, bilat Glaucoma H40031 Glauc, Anat narrow/ angle, rt eye Glaucoma H40032 Glauc, Anat narrow/ angle, lt eye Glaucoma H40033 Glauc, Anat narrow/ angle, bilat Glaucoma H40039 Glauc, Anat narrow/ angle, unsp eye Glaucoma H4011X0 Glauc, POAG, stage unsp Glaucoma H4011X1 Glauc, POAG, mild stage Glaucoma H4011X2 Glauc, POAG, mod st Glaucoma H4011X3 Glauc, POAG, sev st Glaucoma H4011X4 Glauc, POAG, ind st Glaucoma H4010X0 Glauc, unsp O-A, stage unsp Glaucoma H4010X1 Glauc, unsp O-A, mild stage Glaucoma H4010X2 Glauc, unsp O-A, mod st Glaucoma H4010X3 Glauc, unsp O-A, sev st Glaucoma H4010X4 Glauc, unsp O-A, ind st Glaucoma H40051 HTN, Ocular,, rt eye Glaucoma H40052 HTN, Ocular,, lt eye Glaucoma H40053 HTN, Ocular,, bilat Glaucoma H40059 hypertension, Ocular unsp eye Glaucoma H40001 Preglaucoma, unsp, rt eye Glaucoma H40002 Preglaucoma, unsp, lt eye (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 16

17 Glaucoma H40003 Preglaucoma, unsp, bilat Glaucoma H40009 Preglaucoma, unsp, unsp eye Neoplasms D3121 Neoplsm, bngn, right retina Neoplasms D3120 Neoplsm, bngn Unsp retina Neoplasms D3122 Neoplsm bngn, lt retina other E119 DM T2 w/o complications Refraction H52221 Astigmatism, Regular, rt eye Refraction H52222 Astigmatism, Regular, lt eye Refraction H52223 Astigmatism, Regular, bilat Refraction H52229 Astigmatism, Regular, unsp eye Refraction H5200 Hypermetropia, unsp eye Refraction H5201 Hypermetropia, rt eye Refraction H5202 Hypermetropia, lt eye Refraction H5203 Hypermetropia, bilat Refraction H5210 Myopia, unsp eye Refraction H5211 Myopia, rt eye Refraction H5212 Myopia, lt eye Refraction H5213 Myopia, bilat Refraction H524 Presbyopia Retina H35361 Drusen (degen) of macula, rt eye Retina H35362 Drusen (degen) of macula, lt eye Retina H35363 Drusen (degen) of macula, bilat Retina H35369 Drusen (degen) of macula, unsp eye Retina H3530 Macular degen,unsp (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 17

18 Unfortunately, we are still not done! There are numerous codes missing from this list which is simply the top 27 codes the clinic reported. It is no way near complete. Some clinics list ICD-9 codes on their fee tickets/icd-9 cheat sheets. In my enhanced database I currently have dozens and soon will have hundreds of Eyecare fee tickets, both optometry and ophthalmology, from clinics all over the country to determine the top reported codes and also the top codes not reported but should be reported. If your optometry clinic is 75% or more medical or if you are a pediatric, neurological, or retinal, glaucoma or cataract specialist you want an ICD-10 fee ticket/icd-10 list that reflects your business, not the average Eyecare clinic. Examples of codes/conditions rarely reported but should be both documented and reported include: 1. Injury codes in general 2. Injury location codes (home, office, school) 3. Fall codes 4. Expanded headache codes (tension, chronic, migraine) 5. HA as intractable/not intractable 6. Type 1 diabetes mellitus with hypoglycemia 7. Type 1 diabetes mellitus with hyperglycemia 8. Late effect codes (now sequela) 9. Status codes: after cataract, postsurgical 10. Other conditions such as obesity, lupus, thyroid conditions Therefore each custom client will receive a report with a list of additional codes, not normally documented or reported, that should be on the new ICD-10 form and be able to select those they wish to include. Now is the time to increase the level of specificity. If we are going to spend the effort to upgrade to the new ICD-10 system, we should do it correctly. With that said, I know that not every sub-term will be reported so decisions will need to be made at the provider level concerning the level of specificity on the which codes are on the fee ticket and which ones are not. (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 18

19 Included with our custom service will be detailed but not overly technical definitions to help the coding, billing and compliance staff. Below is a sample. A1853 B258 B37 C4411 C692 E0832 E0833 E0834 E0835 E09 G113 G43 Choroiditis (aka chorioretinitis) is where only the choroid is inflamed and not the retina. Cytomegalovirus retinitis (CMV retinitis) is an inflammation of the retina that can cause blindness in AIDS patients. (B25.8; H30.9; P35.1 congenital cytomegalovirus infection). Causes are infectious agents, including toxoplasmosis, cytomegalovirus, and candida. Candida may spread to the retina from the bloodstream, which usually leads to the production of several abscesses in the retina. Basal cell carcinoma is an epithelial tumor of the skin (eyelid) that seldom metastasizes (spreads to other organs). Retinoblastoma is the most common cancer involving the eye in young children is retinoblastoma and the tenth most common pediatric cancer. The ICD-9 code is (Malignant neoplasm of eye retina) and the crosswalk is to C69.2 (Malignant neoplasm of retina). Mild Nonproliferative Retinopathy (diabetic) At this earliest stage, microaneurysms occur. They are small areas of balloonlike swelling in the retina's tiny blood vessels. Moderate Nonproliferative Retinopathy (diabetic) As the disease progresses, some blood vessels that nourish the retina are blocked. Severe Nonproliferative Retinopathy (diabetic) Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment. [all above are background retinopathy] Proliferative Retinopathy At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels with thin, fragile walls which can leak blood, and cause severe vision loss and even blindness. Drugs which commonly cause drug or chemical-induced diabetes mellitus during therapeutic use are the anti-hypertensive vasodilator diazoxide and corticosteroids in high doses such as those used to palliate intracranial tumors. Several drugs, including theophylline, aspirin, isoniazid and nalidixic acid can cause transient hyperglycaemia in overdosage, but only streptozotocin, alloxan and the rodenticide Vacor are likely to cause permanent diabetes. Telangiectasis (or angioectasias) are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. Headaches are reported with status migrainosus or without status migrainosus. The term with status migrainosus means a disabling headache of the migraine type which has lasted for at least 72 hours. (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 19

20 Thank you for reviewing our GEMS on Steroids demonstration. Our comprehensive, customized service is explained below. The EyeCodingForum is now offering an ICD-9 to ICD-10 code conversion service. I have checked other, competing services and most perform a generic GEMS conversion for about $2500. Understand that understanding all the rules, codes, disease options, and making critical decisions concerning which codes to include and which to exclude is not a trivial task. I have personally spent well over 200 hours studying and preparing my ICD-10 for Eyecare training. Plus I have been teaching medical coding and billing for over 15 years. The EyeCodingForum service is personalized, customized and Eyecare specific. We anticipate and fix any areas of vagueness or uncertainty from your ICD-10 code selection. With the expansion of codes in ICD-10 it is simply impossible to get even a marginally correct list of codes on even two pages. Decisions have to be made. The first question is do you want to code to the highest level of specificity and properly report codes using ICD-10 guidelines? If the answer is yes, we can help. Send us a list of either your top 200 codes or the codes from your current fee ticket in a either text or Excel spreadsheet format. We provide multiple options: 1. A customized ICD-10 code list with approximately 150 codes (3 columns of 50) per page. 2. One or two page option (can be any length) 3. Your list of codes and names 4. Updated disease or condition descriptions 5. Fix any current ICD-9 errors 6. Fix all vague descriptions/unspecific ICD-9 codes 7. Optional removal of unspecific diseases, eye or eyelid codes. 8. Add in required or missing diseases/codes 9. Expand to all relevant ICD-10 codes 10. Options for listing laterality, eyelid codes, occurrence codes, and glaucoma stage codes. 11. Options for listing diabetes codes (well over 100) 12. Option for printing wildcards and a 6th & 7th digit legend. (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 20

21 13. Up to 4 hours of conference calls/webinars with the doctors and staff. 14. Audit of up to 20 encounters for documentation errors/improvements. 15. Options for proper injury coding: sequela (late effects), injury (S and T codes), Place of Injury (W and Y codes). 16. Hundreds of alternative, common names for conditions not found in the ICD-10 manual. 17. Expert advice on codes that do not have an ICD-10 crosswalk. 18. One year of EyeCodingForum Webinars (2014) including at least ½ dozen on specific ICD-10 issues. 19. The complete, six-hour, ICD-10 coding for Eyecare online (recorded) course (worth $225) 20. Over one-hundred medical subterms of lesser-known diseases defined. 21. Access to the EyeCodingForum expert staff. 22. Peace of Mind. Take advantage of our expertise and economies of scale. We will perform hundreds of conversions in the next 12 months. We can do it faster, better and less expensively than you could do it yourself. We go to all the bother and reinvent the wheel? Our introductory fee for the custom conversion service above is $1200. There will be a lower-fee, conversion-only option for single provider optometry clinics. If you are interested in knowing the current quality of your ICD-9 code list and how many ICD-10 codes it will expand into, please send it, with your contact information, to ecf@eyecodingforum.com in a spreadsheet format. Be sure to list the ICD-9 codes as text so they do not truncate fifth digits (.00). In addition to your current fee ticket list, be sure to send your top reported ICD-9 codes for a year (generated from your practice management system). There is no fee for this preliminary evaluation. Jeffrey Restuccio, CPC, CPC-H (901) jeff@eyecodingforum.com (901) Jeffrey Restuccio, CPC, CPC-H 12/1/2013 page 21