3rd Party News: 2018 ICD-10 CM Edition

Transcription

1 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 1 Use CNTRL- F to search for a specific diagnosis, term, or ICD code. CONTENTS Refractive Error Pg.2. Lids and Lashes Pg.2. Cornea Pg.3. Conjunctiva P.4. A/C, Pupils, Iris, Sclera P.5. Lens P.5. Vitreous Retina Choroid P.6. Diabetic Retinopathy P.7. IOT and Glaucoma Pp. 8 & 9 Optic Nerve P.9. Macula, Macular Degeneration P.10. Functional (Amblyopia, phorias, etc.) P.10 Strabismus P.11. Systemic Dx. P.11. Visual Field Defect P.11 Blindness & Low Vision P.12. Other (HA, drug therapy, etc.) P.12. Instructions on downloading entire 2018 ICD-10 CM index and tabular list P.13. 3rd Party News: 2018 ICD-10 CM Edition Again this year the NOA has created a special ICD-10 issue of the 3rd Party Newsletter. This edition incorporates the additions and embellishments found in the 2018 revision of ICD-10 CM. These new diagnosis codes must be used when filing claims on or after October 1, How or why should you use this resource? If your claim s diagnosis codes are dependent on electronic health record software, these tables will help confirm the accuracy of your EHR ICD-10 diagnosis coding. If you file otherwise, we think you ll find the following pages more comprehensive and easier to follow than some other resources. You can find a diagnosis code by using the index above, which is based on anatomical location. Or, easier yet, use your computer s CNTRL-F function. Simply hold down the control key on your keyboard and then strike the F key. A box will appear where you can enter the diagnosis term or code of interest. The codes included in this ICD-10 3rd Party Newsletter are those most commonly used by ODs, but our tables are not all-inclusive. Should you need additional help, another resource can be found online at ICD-10 Data.com. If need more help, you have internet access to the entire list of ICD-10 diagnoses online. Go to page 13 of this document for instructions on downloading the entire 2018 ICD-10 CM TABULAR LIST and the 2018 ICD-10 INDEX. We believe our tables to be error free; however, remember that Dr. Quack is a feather-brained duck! We ve done our best, but there are no guarantees...use at your own risk!! We are grateful to Jen Petersen, CPOC, CPOA, billing and insurance coordinator for the Lincoln Vision Center, who created the original matrix upon which these tables are based. We also thank Dr. Jeremy Baumfalk for his editing/suggestions/corrections when these tables were originally instituted. 1

2 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 2 Refractive Error ICD 9 Dx ICD 10 OD OS OU Unspecified Eye Regular Astigmatism H H H H Irregular Astigmatism H H H H Hyperopia H52.01 H52.02 H52.03 H Myopia H52.11 H52.12 H52.13 H52.10 Myopia- Degenerative w/ choroidal neovascularization H44.2A1 H44.2A2 H44.2A3 H44.2A9 Myopia- Degenerative w/ macular hole H44.2B1 H44.2B2 H44.2B3 H44.2B9 Myopia- Degenerative w/ retinal detachment H44.2C1 H44.2C2 H44.2C3 H44.2C9 Myopia- Degenerative w/ foveoschesis H44.2D1 H44.2D2 H44.2D3 H44.2D9 Myopia- Degenerative w/ other maculopathy H44.2E1 H44.2E2 H44.2E3 H44.2E Presbyopia H52.4 V72.0 Routine Eye Exam Z W/O abnormal findings Z01.00.Wth abnormal findings Z01.01 Lids and Lashes ICD 9 Dx ICD 10 OD RT Upper lid RT Lower Lid OD Unspec.Lid OS LT Upper Lid LT Lower Lid OS Unspec. Lid OU Unspecified or Unspecified Eye/ Blepharitis, Unspecified H H H H H H H Blepharoconjunctivitis, Unspecified H H H H Blepharochalsis, Unspecified H02.31 H02.32 H02.33 H02.34 H02.35 H02.36 H Blepharospasm G Chalazion H00.11 H00.12 H00.13 H00.14 H00.15 H00.16 H Dacryocystitis, Unspecified H H H H Dermatochalasis H H H H H H H Dermatitis Allergic H H H H H H H Ecchymosis: Contusion of eyelid & periocular area Initial visit S00.11XA S00.12XA S00.10XA..Subsequent visit S00.11XD S00.12XD S00.10XD..Sequela visit S00.11XS S00.12XS S00.10XS Entropian H H H H H H H Ectropian H H H H H H H & Epiphoria w/excess lacrimation H H H H Epiphoria insufficient drainage H H H H Eyelid Edema H H H H H H H Hordeolum Externum H H H H H H H Meibomianitis (Hordeolum Internum) H H H H H H H Ptosis, Unspecified H H H H Periorbital Cellulitis L Trichiasis w/o Entropian H H H H H H H Benign Neoplasm of Eyelid D

3 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 3 Cornea Pinguecula H H H H Corneal Abrasion w/o foreign body Initial visit S05.01XA S05.02XA S05.00XA..Subsequent visit S05.01XD S05.02XD S05.00XD..Sequela visit S05.01XS S05.02XS S05.00XS Corneal Dystrophy Endothelial H Corneal Dystrophy Unspecified H Corneal Edema, Unspecified H18.20 Corneal Foreign Body Initial visit T15.01XA T15.02XA T15.00XA..Subsequent visit T15.01XD T15.02XD T15.00XD..Sequela visit T15.01XS T15.02XS T15.00XS Corneal Infiltrate H Corneal Neovascularization, Unspecified H H H H Corneal Opacity, Central H17.11 H17.12 H17.13 H17.10 Corneal Opacity, peripheral H H H H Corneal Ulcer, Unspecified H H H H Corneal Ulcer, Central H H H H Dry Eye Syndrome H H H H Keratitis, Unspecified superficial H H H H Keratitis, Punctate H H H H Keratoconus, Unspecified H H H H Keratoconus, Stable H H H H Keratoconus, Unstable H H H H Pterygium, Unspecified H H H H V42.5 Corneal Transplant Status [Secondary diagnosis only] Z Recurrent Corneal Erosion H H H H Herpesviral Keratitis/keratoconjuntivitis B00.52 Herpes Zoster Ocular Disease Unspecified B02.30 Herpes Zoster Ocular Disease Conjunctivitis B Herpes Zoster Ocular Disease Iridocyclitis B02.32 Herpes Zoster Ocular Disease Keratitis B02.33 Herpes Zoster Ocular Disease Scleritis B02.34 Herpes Zoster Ocular Disease Other B

4 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 4 Conjunctiva Conjunctiva Abrasion Initial visit S05.01XA S05.02XA S05.00XA..Subsequent visit S05.01XD S05.02XD S05.00XD..Sequela visit S05.01XS S05.02XS S05.00XS Conjunctiva Concretions H H H H Conjunctiva Foreign Body** Initial visit T15.11XA T15.12XA T15.10XA..Subsequent visit T15.11XD T15.12XD T15.10XD..Sequela visit T15.11XS T15.12XS T15.10XS Conjunctival Hemorrhage H11.31 H11.32 H11.33 H11.30 Chronic Conjunctivitis Unspecified H H H H Acute Conjunctivitis Unspecified H10.31 H10.32 H10.33 H10.30 Acute Atopic Conjunctivitis H10.11 H10.12 H10.13 H10.10 Keratoconjunctivitis due to adenovirus B Conjunctivitis due to adenovirus B30.1 Viral Pharyngoconjunctivitis B30.2 Acute epidemic hemorrhagic conjunctivitis B30.3 Other viral conjunctivitis B30.8 Viral Conjunctivitis Unspecified B Benign Neoplasm Conjunctiva D31.01 D31.02 D Conjunctival Cyst H H H H

5 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 5 A/C, Pupil, Iris, Sclera Episcleritis Unspecified H H H H Hyphema H21.01 H21.02 H21.03 H21.00 Iridocyclitis Primary H H H H Iridocyclitis Recurrent Acute H H H H Iridocyclitis Secondary Infectious H H H H Iridocyclitis Secondary Noninfectious H H H H Iridocyclitis Chronic H20.11 H20.12 H20.13 H20.10 Iridocyclitis Lens-induced H20.21 H20.22 H20.23 H20.20 Iridocyclitis Unspecified H Degeneration of Iris - pigmentary H H H H Pupil Anomaly - other congenital malformation of iris Q13.2 Pupil - unspecified anomaly of pupillary function H57.00 Argyll Robertson Pupil, atypical H Anisocoria H57.02 Miosis H57.03 Mydriasis H57.04 Tonic Pupil H H H H Other anomalies of pupillary function H57.09 Scleritis Unspecified H H H H Anterior Scleritis H H H H Other Scleritis H H H H Unspecified chorioretinal inflammation H30.91 H30.92 H30.93 H Benign Neoplasm Ciliary body D31.41 D31.42 D31.40 Lens Cataract Incipient "Other" H H H H Cataract Anterior subcapsular H H H H Cataract Poster subcapsular H H H H Cataract Cortical Incipient H H H H Cataract Nuclear sclerotic H25.11 H25.12 H25.13 H Cataract Mature - Other Age Related Cataract H Cataract Hypermature morgagnian H25.21 H25.22 H25.23 H Aphakia H27.01 H27.02 H27.03 H27.00 V43.1 Pseudophakia [Secondary diagnosis only] Z Capsular Haze - other secondary cataract H H H H

6 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 6 Vitreous Crystalline Deposits in Vitreous Body (asteroid hyalosis) H43.21 H43.22 H43.23 H Vitreous Degeneration (detachment) H H H H Vitreous Hemorrhage H43.11 H43.12 H43.13 H Other Vitreous Opacities (floaters) H H H H Retina Choroid Chorodial Nevus D31.31 D31.32 D Chorioretinitis - Unspecified disseminated Chorioretinal inflammation H H H H Chorioretinal Scar - Unspecified H H H H Retinal Detachment - Unspecified - with break [new or old] H H H H Retinal Detachment -Serous - w/o break H33.21 H33.22 H33.23 H Retinoschisis - Unspecified H H H H Retinal break w/o detachment - Unspecified H H H H Retinal HorseshoeTear w/o detachment H H H H Retinal Hole H H H H Hypertensive Retinopathy H H H H Retinal Vascular Occlustion H34.9 Central Retinal Vein Occlusion with Macular Edema H H H H Central Retinal Vein Occlusion with Retinal Neovacularization H H H H Central Retinal Vein Occlusion - Stable H H H H Tributary Retinal Vein Occlusion with Macular Edema H H H H Tributary Retinal Vein Occlusion with Retinal Neovacularization H H H H Tributary Retinal Vein Occlusion - Stable H H H H Retinal Drusen (macula) H H H H Retinal Degeneration Peripheral - Unspecified H Lattice Degeneration H H H H Retinitis Pigmentosa - Pigmentary Retinal Dystrophy H Retinal Pigment Epithelium Dystrophy H Retinal Hemorrhage H35.61 H35.62 H35.63 H Retital Exudates/Deposits - Other Specified Retinal Disorders H Retinal Edema H

7 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 7 TYPE 1 Diabetic Retinopathy WITHOUT Macular Edema ICD 9 ICD 10 OD OS OU Unspecified eye Non-proliferative Mild E E E E Non-proliferative Moderate E E E E Non-proliferative Severe E E E E Proliferative E E E E TYPE 1 Diabetic Retinopathy WITH Macular Edema ICD 9 ICD 10 OD OS OU Unspecified eye Non-proliferative Mild E E E E Non-proliferative Moderate E E E E Non-proliferative Severe E E E E Proliferative E E E E Resolved following treatment E10.37X1 E10.37X2 E10.37X3 E10.37X9 TYPE 1 Diabetic Retinopathy WITH Retinal Detachment ICD 9 ICD 10 OD OS OU Unspecified eye Prolifrtive retinopthy w/ tractional detachmt involving macula E E E E Prolifrtive retinopthy w/ tractional detachmt NOT involving macula E E E E Prolif. Retpthy w/ tractional & rhegmatogenous detachment E E E E TYPE 2 Diabetic Retinopathy WITHOUT Macular Edema ICD 9 Requires 2nd code: use of Z79.4 insulin; Z79.84 oral medication ICD 10 OD OS OU Unspecified eye Non-proliferative Mild E E E E Non-proliferative Moderate E E E E Non-proliferative Severe E E E E Proliferative E E E E TYPE 2 Diabetic Retinopathy WITH Macular Edema ICD 9 Requires 2nd code: use of Z79.4 insulin; Z79.84 oral medication ICD 10 OD OS OU Unspecified eye Non-proliferative Mild E E E E Non-proliferative Moderate E E E E Non-proliferative Severe E E E E Proliferative E E E E Resolved following treatment E11.37X1 E11.37X2 E11.37X3 E11.37X9 TYPE 2 Diabetic Retinopathy WITH Retinal Detachment ICD 9 ICD 10 OD OS OU Unspecified eye Prolifrtive retinopthy w/ tractional detachmt involving macula E E E E Prolifrtive retinopthy w/ tractional detachmt NOT involving macula E E E E Prolif. Retpthy w/ tractional & rhegmatogenous detachment E E E E

8 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 8 IOT & Glaucoma ICD 9 Glaucoma Suspect OD OS OU Unspecified eye Open Angle with borderline findings Low Risk H H H H Open Angle with borderline findings High Risk H H H H Anatomical Narrow Angle H H H H Ocular Hypertension H H H H Primary Open Angle Glaucoma OD OS OU Unspecified eye Open Angle Glaucoma Stage Unspecified H H H H Open Angle Glaucoma Mild H H H H Open Angle Glaucoma Moderate H H H H Open Angle Glaucoma Severe H H H H Open Angle Glaucoma Indeterminate H H H H Primary Angle Closure Glaucoma Unspecified [PCAG ICD-10 codes are not broken down by eye] Primary Angle Closure Glaucoma Unspecified Primary Angle Closure Glaucoma Mild Primary Angle Closure Glaucoma Moderate Primary Angle Closure Glaucoma Severe Primary Angle Closure Glaucoma Indeterminate ICD-10 H40.20X0 H40.20X1 H40.20X2 H40.20X3 H40.20X4 Low Tension Glaucoma (2ndary to POAG) OD OS OU Unspecified eye Low Tension Glaucoma Stage Unspecified H H H H Low Tension Glaucoma Mild H H H H Low Tension Glaucoma Moderate H H H H Low Tension Glaucoma Severe H H H H Low Tension Glaucoma Indeterminate H H H H Pigmentary Glaucoma (2ndary to POAG) OD OS OU Unspecified eye Pigmentary Glaucoma Stage Unspecified H H H H Pigmentary Glaucoma Mild H H H H Pigmentary Glaucoma Moderage H H H H Pigmentary Glaucoma Severe H H H H Pigmentary Glaucoma Indeterminate H H H H GLAUCOMA & OPTIC NERVE CONTINUED. 8

9 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 9 Capsular Glaucoma with Pseudoexfoliation OD OS OU Unspecified eye Capsular Glaucoma w/pseudoexfoliation Unspecified H H H H Capsular Glaucoma w/pseudoexfoliation Mild H H H H Capsular Glaucoma w/pseudoexfoliation Moderate H H H H Capsular Glaucoma w/pseudoexfoliation Severe H H H H Capsular Glaucoma w/pseudoexfoliation Indeterminate H H H H Steroid Responder H H H H Intermittent Angle Closure Glaucoma H H H H Acute Angle Closure Glaucoma H H H H Chronic Angle Closure Glaucoma OD OS OU Unspecified eye Chronic Angle Closure Glaucoma stage Unspecified H H H H Chronic Angle Closure Glaucoma Mild H H H H Chronic Angle Closure Glaucoma Moderate H H H H Chronic Angle Closure Glaucoma Severe H H H H Chronic Angle Closure Glaucoma Indeterminate H H H H Optic Nerve Ischemic Optic Neuropathy H H H H Optic Atrophy, Unspecified H47.20 Optic Atrophy, Primary H H H H Optic Atrophy, Hereditary H47.22 Optic Atrophy, Glaucomatous H H H H Optic Atrophy, Other H H H H Optic Disc Drusen H H H H Optic Neuritis H46.01 H46.02 H46.03 H Papilledema unspecified H47.10 Papilledema associated with retinal disorder (choked disc) H47.13 Foster-Kennedy syndrome H H H H Papillitis H46.01 H46.02 H46.03 H Pseudopapilledema H H H H

10 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 10 Macular Degeneration ARMD Unspecified Macular Degeneration H35.30 ARMD Non-Exudative Stg. Unspecified H H H H ARMD Non-Exudative Early Dry H H H H ARMD Non-Exudative Interm. Dry H H H H ARMD Non-Exudative Advanced W/O sub-foveal involvement H H H H ARMD Non-Exudative Advanced With sub-foveal involvement H H H H OD OS OU Unspecified eye ARMD Exudative Stg. Unspecified H H H H ARMD Exudative With Active Choroidal Neovacularization H H H H ARMD Exudative With Inactive Choroidal Neovacularization H H H H ARMD Exudative with Inactive Scar H H H H Macula Macular CME H H H H Macular Cyst, Hole or Pseudohole H H H H Puckering of macula H H H H Functional Aniseikonia H Accommodative Paresis H H H H Amblyopia Unspecified H H H H Amblyopia Suspect H H H H Photophobia - Asthenopia - Visual discomfort H H H H Diplopia H Fusion Problems - Fusion w/defective Stereopsis H Hyperphoria - Vertical heterophoria H Esophoria H Exophoria H Convergence Insufficiency H Convergence Excess H Nystagmus - Unspecified H Eyepain - Ocular Pain H57.11 H57.12 H57.13 H

11 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 11 Systemic ICD 9 Dx ICD Diabetes Type II - without complications E Diabetes Type I - without complications E Pre-Diabetes R Pre-Diabetes - Other abnormal glucose R Multiple Sclerosis G Myasthenia Gravis w/o exacerbation G Exophthalmos Unspecified H Dermatitis of Skin Unspecified L TIA Unspecified G Rheumatoid Arthritis M Osteoarthritis - Unspecified M19.90 Strabismus Esotropia Unspecified H Esotropia Monocular H H Esoptropia Alternating H50.05 Exotropia Unspecified H Exotropia monocular H H Exotropia Alternating H Other Paralytic strabismus H H H H Third Nerve Palsy H49.01 H49.02 H49.03 H Fourth Nerve Palsy H49.11 H49.12 H49.13 H Sixth Nerve Palsy H49.21 H49.22 H49.23 H49.20 Visual Field Defect Visual Field Defect Unspecified H53.40 Central Scotoma H H H H Scotoma of blind spot H H H H Sector or arcuate defect H H H H Other localized defect H H H H Generalized contraction of visual field H H H H Right Side Left Side Unspecified side Homonymous bilateral field defect H H H Heteronymous bilateral field defect H

12 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 12 Blindness and Low Vision Dx Categories Category 1: 20/70-20/200 Category 2: 20/200-20/400 Category 3: 20/400-20/1200 Category 4: 20/1200 to light perception only Category 5: NLP BLINDNESS BOTH EYES Blind OS Catgy 3 Blind OS Catgy 4 Blind OS Catgy 5 ~Blind OD Category 3 H54.0X33 H54.0X34 H54.0X35 ~Blind OD Category 4 H54.0X43 H54.0X44 H54.0X45 ~Blind OD Category 5 H54.0X53 H54.0X54 H54.0X55 BLIND OD & LOW VISION OS Lw Visn OS Catgy 1 Lw Visn OS Catgy 2 ~Blind OD Category 3 H H ~Blind OD Category 4 H H ~Blind OD Category 5 H H BLIND OS & LOW VISION OD Lw Visn OD Catgy 1 Lw Visn OD Catgy 2 ~Blind OS Category 3 H H ~Blind OS Category 4 H H ~Blind OS Category 5 H H LOW VISION BOTH EYES Lw Visn OS Catgy 1 Lw Visn OS Catgy 2 ~Low Vision OD Category 1 H54.2X11 H54.2X12 ~Low Vision OD Category 2 H54.2X21 H54.2X22 NORMAL VISION IN ONE EYE AND LOW VISION IN THIS EYE Lw Visn OD Catgy 1 Lw Visn OD Catgy 2 Lw Visn OS Catgy 1 Lw Visn OS Catgy 1 ~Normal vision in one eye & low vision in other eye H54.511A H54.512A H54.52A H54.52A2 NORMAL VISION IN ONE EYE AND BLIND IN THIS EYE Blind OD Catgy 3 Blind OD Catgy 4 Blind OD Catgy 5 Blind OS Catgy 3 Blind OS Catgy 4 Blind OS Catgy 5 ~Normal vision in one eye & blind in other eye H54.413A H54.414A H54.415A H54.42A3 H54.42A4 H54.42A5 Other V58.69 Long term (current use) of drug therapy - other Z Amaurosis Fugax G Color Deficiency - Unspecified Hereditary Retinal Dystrophy H Headache R Migraine w/ Aura, Not retractable, w/o status migrainosus G Migraine w/o Aura, Not retractable, w/o status migrainosus G Photophobia - Visual Discomfort H H H H Albinism Unspecified E70.30 Ocular Albinism Unspecified E Facial Myokymia G Berlin's Disease - Other injuries of eye and orbit S05.8X1 S05.8X2 S05.8X Visual Disturbance Unspecified H

13 2018 ICD-10 Special Edition of the NOA 3rd Party Newsletter Page 13 Instructions on downloading the 2018 ICD-10 CM Index and the 2018 ICD-10 CM Tabular List On occasion the code you are seeking may not be available in the previous 12 pages. CMS has made the thousands of pages of the ICD-10 CM index and tablular list available for download. Simply follow the directions below, and then use the CNTRL-F function to search the index and tabular list for the diagnosis or code of interest. 1. Go to the CMS 2018 ICD-10 CM and GEMS web page (screenshot at right). 2. Click on the download 2018 Code Tables and Index [ZIP 20MB] 3. All of the files in the red box will be downloaded to your computer. You are only interested in the two large pdf files circled in red. 4. Save those two files to a special folder on your computer. 5. When you want to find a particular diagnosis term or code, go to the folder containing those files and: A. Open the icd10cm_index_2018.pdf file. B. Use CNTL-F to search for the diagnosis term in question. C. Once your term is found in the index, note or copy its corresponding ICD-10 root (non-billable) diagnosis code. D. Now open the icd10cm_tabular_2018.pdf file. E. Use CNTL-F to search for the root diagnosis code you just copied from the index file. F. Most likely your tabular list search will reveal a number of billable diagnosis codes from which to chose. Of the codes found, always chose the most specific code appropriate for the patient s condition. Specificity is important. 13