Introduction to ICD-10 Eye Anatomy. Jeffrey Restuccio, CPC, CPC-H, MBA EyeCodingForum.com (901)

Transcription

1 Introduction to ICD-10 Eye Anatomy Jeffrey Restuccio, CPC, CPC-H, MBA EyeCodingForum.com (901)

2 A Little about Me I have been teaching coders, billers and providers for over 15 years. I have help certified over 1,000 coders. I also audit thousands of medical records. I have been teaching a live EyeCare coding, billing, and documentation course since 2007; in all, I have taught well over 200 live classes and have hundreds of students nationwide. I teach both coding and billing and ICD-10 for Eyecare. EyeCodingForum 2

3 Importance of Eye Anatomy For proper ICD-9, CPT and surgical coding you need to know: The Anterior Segment The Posterior Segment The External Ocular Adnexa of the Eye This is how the CPT manual is arranged and segments are referenced often. EyeCodingForum 3

4 Anatomy of the Eye Segments are not Chambers The eyeball is divided into three chambers: 1. Anterior Chamber: lies between the cornea and the iris 2. Posterior Chamber: lies between the iris and the lens. 3. Vitreous chamber: lies between the lens and the back of the retina. The first two are the anterior segment; the third the posterior segment. EyeCodingForum 4

5 Anatomy of the Eye Anterior Segment includes: Cornea Anterior chamber Anterior sclera Iris Ciliary body Lens EyeCodingForum 5

6 Anterior Segment Cornea Anatomy of the Eye The anterior (front) portion of the outer layer of the eye made of fibrous, transparent tissue that extends over the pupil. Its main function is to refract rays of light so that they are properly focused on the receptor cells found in the posterior region of the eye. EyeCodingForum 6

7 Anatomy of the Eye Cornea has five layers: The cornea has five layers (anterior to posterior): 1. Epithelium 2. Bowman s layer. 3. Stroma 4. Descemet membrane 5. Endothelium EyeCodingForum 7

8 Anatomy of the Eye Anterior Segment -- Anterior chamber The space between the cornea and the iris of the eye. EyeCodingForum 8

9 Anatomy of the Eye Anterior Segment -- Anterior chamber angle Formed by the inner cornea and the root of the iris. 1. The Trabecular meshwork: responsible for draining the aqueous humor from the eye via the anterior chamber 2. Schlemms Canal: a set of tubes that allows fluid to drain into the blood system. Both structures are critical to understanding glaucoma and its treatment. EyeCodingForum 9

10 Anatomy of the Eye Anterior Segment -- Iris ciliary body Iris: Colored portion of the eye which surrounds the pupil. Ciliary body: secrets aqueous fluid; controls shape of lens. EyeCodingForum 10

11 Anatomy of the Eye Anterior Segment Zonules Zonules of Zinn: are a ring of fibrous strands, called firbillin, connecting the ciliary body with the lens. Mutations can lead to Marfans Syndrome. EyeCodingForum 11

12 Anatomy of the Eye Anterior Segment - Lens A transparent structure that rests behind the pupil consisting of an inner nucleus and an outer cortex which is surrounded by a cellophane-type capsule. The lens focuses light rays into images on the retina. EyeCodingForum 12

13 Anatomy of the Eye Posterior Segment includes: Vitreous Humor Retina Choroid Sclera Macula EyeCodingForum 13

14 Anatomy of the Eye Posterior Segment Vitreous Humor The clear, jelly-like substance found behind the lens that maintains the shape of the eyeball. EyeCodingForum 14

15 Anatomy of the Eye Posterior Segment Fovea / Macula Lutea Age-Related Macular Degeneration ARMD is the leading cause of blindness in the US. EyeCodingForum 15

16 Anatomy of the Eye Posterior Segment Fovea / Macula Lutea EyeCodingForum 16

17 Anatomy of the Eye Posterior Segment - Retina The light-sensitive, inner layer of the eye that contains receptor cells called rods and cones. EyeCodingForum 17

18 Anatomy of the Eye Posterior Segment Other Layers These structures are between the choroid and the anterior surface of the retina. Bruch's membrane Pigment epithelial cells are like a row of bricks laying on Bruch's membrane. Photoreceptors (rods, dim light and cones, bright light and visual acuity) 7 or 8 layers of nerve tissue lie above the photoreceptors. Image on next slide. EyeCodingForum 18

19 Anatomy of the Eye Posterior Segment Other Layers The retina has many layers, not just one. EyeCodingForum 19

20 Anatomy of the Eye Posterior Segment - Choroid The choroid is the layer of the eye behind the retina that contains major blood vessels. The choroid feeds the retina. EyeCodingForum 20

21 Anatomy of the Eye Posterior Segment - Sclera The sclera, or white of the eye. It is the tough, opaque tissue that serves as the eye's protective outer coat. EyeCodingForum 21

22 Anatomy of the Eye External Ocular Adnexa - Orbit A protective house for the eyes, blood vessels, nerves and extraocular muscles. EyeCodingForum 22

23 Anatomy of the Eye Orbital walls Seven bones Frontal bone: Top part Zygomatic bone: roof Lacrimal bone: medial wall Ethmoid bone: medial wall Maxillary bone: orbital floor (subject to blowout fracture.) Sphenoid bone: back of the orbit Palatine bone: middle of the orbit EyeCodingForum 23

24 Orbital Bones The seven bones that articulate to form the orbit. yellow = Frontal bone green = Lacrimal bone brown = Ethmoid bone blue = Zygomatic bone purple = Maxillary bone aqua = Palatine bone red = Sphenoid bone Latin orbitae How do you Code a Rule- Out of a Blowout fracture? Blowout Fracture EyeCodingForum 24

25 Anatomy of the Eye External Ocular Adnexa - Eyelids Protect the vulnerable surface of the eye from trauma and drying. EyeCodingForum 25

26 Anatomy of the Eye Ocular Adnexa - Conjunctiva A thin, transparent membrane that lines the eyelids and coats the anterior portion of the eyeball over the white of the eye. EyeCodingForum 26

27 Anatomy of the Eye External Ocular Adnexa: Conjunctiva - Lacrimal system Structures that secrete tears. Note that there is an inferior and a superior punctum. EyeCodingForum 27

28 Anatomy of the Eye Six Eye muscles: 4 rectus; 2 oblique Rectus muscles; insert at the sclera, behind the limbus. These muscles Move the eye up or down or at an angle. 1. Superior 2. Inferior 3. Medial rectus all three controlled by the oculomotor nerve (III) 4. Lateral rectus controlled by abducens (VI) nerve Oblique muscles; insert at the sclera, behind the limbus. These move the eye horizontally, right or left. 1. Superior Oblique 2. Inferior Oblique Mostly responsible for rotation EyeCodingForum of the eye sideways. 28

29 Optic Nerve The optic nerve, also called cranial nerve II, transmits visual information from the retina to the brain. Glaucoma, optic neuritis, optic nerve hypoplasia, trauma and anterior optic neuropathy are common diseases that impact the optic nerve. EyeCodingForum 29

30 Example of Anatomy and Coding (1) Repair of laceration; cornea... not involving "uveal tissue (estimated Medicare allowable amount is $648 [RVU = 10.9]) Repair of laceration; cornea... with... "uveal tissue (estimated Medicare allowable amount is $1065 [RVU = 18.07). If the coder never asks and the surgeon never documents that uveal tissue was involved, then this procedure will never be reported correctly. The difference is $417! Where and what exactly is the uvea? The uvea is the: iris, ciliary body and the choroid. These are all contiguous structures of the eye. EyeCodingForum 30

31 Example of Anatomy and Coding (2) Codes to are destruction codes that reference a "cutaneous vascular proliferative lesion. The RVU (relative value unit) for is 10.09; approximate payment (2013) in TN is $ The RVU for (excision benign lesion eyelids.5 cm or less) is 4.09; approximate payment (2013) in TN is $ That s a significant difference! If the coder never asks and the surgeon never documents the specific term cutaneous vascular proliferative lesion then these procedures will never be reported correctly. EyeCodingForum 31

32 Cutaneous Vascular Proliferative Lesion One term is hemagioma. Another term is Port Wine Stain. This could be on their face and eyelid. Another term is a strawberry birthmark. EyeCodingForum 32

33 Lens Codes You will see these terms a lot in ICD-10 Anterior Subcapsular: The front portion of the capsule that contains the nucleus and cortex of the lens. Posterior Subcapsular: the back portion Cortical: the cortex of the lens Nuclear: the nucleus of the lens Please try to avoid, Cataract, unspecified. EyeCodingForum 33

34 Eye Anatomy Summary Know the Anterior Segment Know the Posterior Segment Know the External Adnexa of the Eye Be able to relate eye anatomy to both ICD- 9/ICD-10 diagnostic codes and CPT procedural codes. Always ask your provider if you are unclear about eye anatomy. EyeCodingForum 34

35 Introduction to ICD 10 coding for Eyecare Jeffrey Restuccio, CPC, CPC H, MBA Coding and Billing Consultant specializing in Eyecare Memphis TN (901) EyeCodingForum.com 35

36 Specifics ICD 10 CM is an updated system for the reporting of diseases, conditions and other factors affecting healthcare (i.e., injuries and adverse effects). Each ICD 10 CM code consists of 3 to 7 characters, the first being a letter of the alphabet (alpha character), the second a number, and the rest either alpha or numeric. New ICD 10 codes must be used on and after Oct ICD 10 has 68,000 codes compared to only 13,000 ICD 9 codes. EyeCodingForum.com 36

37 ICD Coding Basics The CM means clinical modifications and is unique to the descriptions of the codes used in the United States. ICD has three volumes. The third volume of ICD 9 is ICD 9 PCS; this becomes ICD 10 PCS, and only used for inpatient (hospital) coding. Outpatient clinics do not need the third volume. Practitioners in hospitals, will be required to begin using ICD 10 PCS codes to describe health care procedures and treatments provided to inpatients as well as the ICD 10 CM codes to describe diagnoses (volumes 1 and 2). Again, the third volume is is not needed for outpatient clinics. EyeCodingForum.com 37

38 HIPAA Non Covered Entities All Health Insurance Portability and Accountability Act (HIPAA) of 1996 covered entities MUST implement the new code sets with dates of service, or date of discharge for inpatients, that occur on or after October 1, Includes: worker's compensation, disability and auto insurers. Therefore, your PM system and your clinic must be able to switch to ICD 9 codes if WC above does not convert. The probability is high that most, if not all WC agencies will convert in Be sure to contact your state agency. EyeCodingForum.com 38

39 Why upgrade to ICD 10? The International Association of Industrial Accident Boards and Commissions stakeholders will certainly identify ways to use this information in new and powerful ways: Allow for much greater specificity and accuracy in diagnosis. Aid in the development of fee schedules and pricing schemes. Help in managing the utilization review process. Provide an opportunity for greater measurement of the quality and efficacy of medical care. Necessary for research Some categories (infectious diseases) have run out of room for new codes. EyeCodingForum.com 39

40 What is ICD 11? I heard we will just wait for ICD 11. This is just being rolled out, internationally, now. ICD 10 is the pathway to ICD 11. As you will learn today, over 90% of what you will learn today, you can implement today. Right now. The majority of the training focuses on documentation and translating how the provider documents and then the coder interprets and translates the written documentation to actual codes. ICD 11 builds on ICD 10. You must learn ICD 10 first, then ICD 11, but I think it will be at least ten years before we upgrade again. EyeCodingForum.com 40

41 ICD 10 Code Format [ ] [ ] [ ]. [ ] [ ] [ ] [ ] Category (letter), etiology, anatomic site, severity and then a seventh digit "extender" B20 Human immunodeficiency virus [HIV] disease D3132 Benign neoplasm of left choroid E119 Type 2 diabetes mellitus without complications H0011 Chalazion right upper eyelid H4011X1 Primary open angle glaucoma, mild stage H5211 Myopia, right eye H524 Presbyopia R51 Headache T1502XA Foreign body in cornea, left eye, initial encounter Z961 Presence of intraocular lens EyeCodingForum.com 41

42 Why Are There So Many Codes? Much of the increase is due to the addition of laterality and bilateral anatomy and disease codes (right, left, bilateral, and unspecified). In other words, each eye condition or disease will have four codes instead of one. However I do not recommend including unspecified eye on your fee ticket or ever reporting it. There is also some increased specificity. Some ICD 9 combination codes will become two codes. There are new disease phrasing and coding guidelines in ICD 10. The largest increase in codes, relevant to Eyecare, is in diabetes and glaucoma codes. EyeCodingForum.com 42

43 Won t my Billing System do all of this for me? Is simply upgrading your practice management system or electronic health records systems sufficient to properly document and report ICD 10 codes? Won t it have everything I need? The simple answer is No. The reasons include: lack of crosswalk of some codes, lack of complete definitions, lack of acronyms and common terminology, lack of enhanced descriptions and explanations, and lack of coding guideline information. Plus, the provider must document the specific medical diagnoses clearly in the medical record. The documentation comes first then the specific diagnosis codes are translated into codes and entered into the practice management system. EyeCodingForum.com 43

44 Learn ICD 9 Guidelines Now! Before you can learn ICD 10 guidelines you need to learn ICD 9 guidelines. Many Eyecare professionals have never had formal ICD 9 coding training. The top ICD 9 concepts most Eyecare professionals do not know: 1. 5 th digit specificity for certain codes. 2. Reporting two codes when required, instead of just one (i.e., diabetic cataracts). 3. Combination codes (reporting one code for two conditions). 4. Late effects. 5. Reporting E codes, one for the injury, and one for the location of the injury. 6. Reporting E codes for adverse effects. 7. Screening V codes. (i.e., V72.0) [V codes become Z codes in ICD 10.] EyeCodingForum.com 44

45 Action Plan to Prepare for ICD Circle all unspecific ICD 9 codes in your current fee ticket/icd 9 cheat sheet/provider documentation. 2. You should generate a list every ICD 9 code you have report for the last 12 months from your PM system. You can use this list to create your new ICD 10 fee ticket or cheat sheet. 3. Decide how codes are selected. Are you are going to code from the manual, a cheat sheet or a look up program to select the new ICD 10 codes? 4. All fee tickets must be reworked. Recommendation is between three to six months before Oct Remember, the number of codes expand over 4X. EyeCodingForum.com 45

46 How you determine your documentation Discuss with your provider if it is reasonable to provide additional documentation and more specificity. Discuss if a jury of their peers would agree if called before an optometry board, Medicaid, VSP, or Medicare panel concerning documentation. EyeCodingForum.com 46

47 ICD 10 Training 1. The majority of ICD 9 codes in Eyecare crosswalk cleanly to ICD 10. However, it s the other 10 15% diseases coded differently and exceptions that will cause the most problems in denied claims. 2. The goal is to create good documentation and coding habits. 3. Starting now, conduct a documentation audit of provider documentation every three months. 4. Note the difference between a unspecified eye and an unspecified diseases. These are separate issues. EyeCodingForum.com 47

48 Added specificity = Subterms I call them sub terms in this course. They are also increased specificity: Regular or irregular for astigmatism. Stable or unstable for keratoconus Internal or external ophthalmoplegia. Wet or dry for ARMD. EyeCodingForum.com 48

49 Audit for Specificity Accurate, specific, well documented encounters, that clearly reflect a knowledge of coding guidelines and documentation requirements are much more likely to sail through an audit. Avoid unspecified: Diabetes Mellitus Astigmatism Keratoconus Cataracts Headaches Keratitis ARMD Conjunctivitis Entropion Adverse effects Ectropion Reason and location of accidents Lagophthalmos Epiphora EyeCodingForum.com 49

50 Coding From the Manual In a large ophthalmology office, a certified coder will read the provider s documentation and translate the actual notes to codes that are reported to the insurance company. In the typical optometrist office the codes are selected from a fee ticket or cheat sheet. We will not look up ICD 10 codes in this course. For one, most of you do not yet have ICD 10 manuals. Second, it is timeconsuming and third, I hate coding from the manual, personally. However, there is information in the manual critical to accurate coding. This information is missed when coding from a look up program or cheat sheet. EyeCodingForum.com 50

51 ICD 10 Manual: Includes and Excludes In the manual, be sure to always read the Includes and Excludes note below every ICD 10 code selected. Implementation of ICD 10 is the best time to thoroughly review all disease codes and conditions for your clinic. It is preferable to discuss what will be documented specifically and which unspecified codes will be reported rather than allow a wide variance in documentation among your providers (or only report unspecific codes). EyeCodingForum.com 51

52 ICD 10 Excludes 1 and 2 ICD 10 CM has two types of excludes notes. Exclude 1 Indicates that the code excluded should never be reported at the same time as the code in this section. Exclude 2 Indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. Means not included but may be reported together if documentation supports. Example: H43.8 Other disorders of vitreous body Excludes 1: proliferative vitreo retinopathy with retinal detachment (H33.4*) Excludes 2: vitreous abscess (H44.02*) EyeCodingForum.com 52

53 Other Questions How does this affect HCPC codes? Not at all. Includes S0620, S0621, V2020 etc How does this affect the modifiers RT, LT, 50, and E1 E4 I use with CPT and HCPC codes? Not at all. They simply must now match the ICD 10 code for laterality. EyeCodingForum.com 53

54 ICD 10 Highlights Laterality: Document and report eye conditions by eye when applicable. The right, left and bilateral eye conventions are:.**1 = right eye.**2 = left eye **3 = bilateral (both eye) **9 = unspecified eye [recommend not using] Sometimes unspecified eye is a 0 and not a 9. Throughout this course I will list the right eye or eyelid only when there is laterality. [All my notes are in brackets to the right of the code.] EyeCodingForum.com 54

55 Myopia All four codes are listed below. For the majority of codes, I will list only the right eye (digit=1). Myopia=nearsightedness. Patient can see close up. Eyeball is too long. H52.10 Myopia, unspecified eye [exception] H52.11 Myopia, right eye H52.12 Myopia, left eye H52.13 Myopia, bilateral EyeCodingForum.com 55

56 Eyelid Codes ICD 10 Eyelid Codes follow the HCPCS E codes (1 4) There are now seven options for each eyelid!.**1 = RUL (Right Upper Lid).**2 = RLL (Right Lower Lid).**3 = Right Eye (unspec) I don't know which lid Don t Use.**4 = LUL (Left Upper Lid).**5 = LLL (Left Lower Lid).**6 = Left Eye but I don't know which lid Don't Use.**9 = I don't know which lid or which eye Don't Use EyeCodingForum.com 56

57 Lacrimal Gland Codes Lacrimal Gland Codes (1,2,3, 9) map to RT, LT, bilateral and unspecified. H Acute dacryoadenitis, right lacrimal gland H Acute dacryoadenitis, left lacrimal gland H Acute dacryoadenitis, bilateral lacrimal glands H Acute dacryoadenitis, unspecified lacrimal gland EyeCodingForum.com 57

58 Conditions without Laterality These are not reported by eye. H53.2 diplopia is a 4 digit code. By its very nature, it only applies to both eyes therefore only one selection, not four. Diabetes codes In ICD 10 just one code. No laterality (not by eye). ARMD codes No laterality (not by eye). H53.10 Unspecified subjective visual disturbances H53.16 Psychophysical visual disturbances H53.19 Other subjective visual disturbances H53.8 Other visual disturbances H53.9 Unspecified visual disturbance EyeCodingForum.com 58

59 The ICD 10 X Placeholder Code Occasionally one will find an X character in the middle of an ICD 10 code. Example: T15.01X* Foreign body in cornea, right eye In this case, the X in the sixth digit position serves as a placeholder so that the seventh character is in the correct position. Without the placeholder, the resulting code would be invalid. Placeholder codes will also be in ICD 10 glaucoma codes. Note: I will be using an * (asterisk) as a wild card character throughout this course. I will not be using an X because it is now a valid character anywhere in the code. EyeCodingForum.com 59

60 Occurrence codes All injury codes will now have the following occurrence codes and an X placeholder code. Foreign Body (FB) codes (Note: XA, XD and XS) Initial, Subsequent and Sequela: T15.01XA Foreign body in cornea, right eye, initial encounter T15.01XD Foreign body in cornea, right eye, subsequent encounter T15.01XS Foreign body in cornea, right eye, sequela Note: all above are for the right eye; fifth digit = 1. EyeCodingForum.com 60

61 ICD 10 Exceptions The injury codes (S and T), do not have a bilateral eye code. There is no 3 option. In other words, if the person has a FB in both eyes, you should list two ICD 10 codes, not one. The eyelid laterality codes do not include an all eyelids option. In other words, if someone has blepharitis in all four eyelids, you must report four ICD 10 codes, not one. Some G codes, like blepharospasm, do not have laterality. Just remember, that outside of the H** codes, that there will be exceptions to right=1 and left=2 rule. EyeCodingForum.com 61

62 Late Effects and Occurrence codes The term "Late Effect" is not found in ICD 10. They are now listed as Sequela, which are reported using the external cause code with the 7th character S for sequela (sequelae is plural). Like late effects, a sequela can occur at any time after the initial injury. One example of a angle recession glaucoma. The most common sequelae in ICD 10 would be from burns, foreign bodies, or penetrating injuries to the eyes and adnexa. T15.01XS Foreign body in cornea, right eye, sequela EyeCodingForum.com 62

63 Routine Eye Exam V72.0: routine exam of eyes ICD 9 code changes to two codes with ICD 10. The word routine is no longer in the description. Z01.00 Encounter for examination of eyes and vision without abnormal findings. Z01.01 Encounter for examination of eyes and vision with abnormal findings. It will be very important to monitor how insurance companies reimburse based on the two ICD 10 codes linked to office visits. EyeCodingForum.com 63

64 More Highlights Diseases will be A and B codes. Neoplasms, will be C malignant and D benign. There is no "senile cataract" description in ICD 10; They are now listed as "age related." E codes (Accidents, poisonings, injuries, adverse effects) become S and T codes in ICD 10. W and Y codes are used to indicate activities and locations for injuries and accidents. EyeCodingForum.com 64

65 H52.***: Refraction Disorders These are not medical diagnoses. They should primarily be used with CPT code While some medical insurance carriers and most vision plans accept them as linked diagnoses, the ICD 10 Z01.** routine vision exam codes below should be linked to 920** and 992** office visits when there is no medical diagnosis. Medicare never pays on and refraction diagnosis codes. However some medical insurance carriers pay on medical diagnosis codes linked to When linking to an office visit, either the 992xx or a 920xx code, I recommend the ICD 10 Z01.00 (without abn. Findings or Z01.01 (with abn. Findings) codes. However, individual carriers or vision plans may have a different requirement. EyeCodingForum.com 65

66 Hyperopia Hypermetropia = hyperopia=farsightedness. Patient can see in the distance. Eyeball is too short. H52.00 Hypermetropia, unspecified eye [exception of zero] H52.01 Hypermetropia, right eye H52.02 Hypermetropia, left eye H52.03 Hypermetropia, bilateral Emmetropia: normal refractive status has no ICD 10 code. EyeCodingForum.com 66

67 Myopia Myopia=nearsightedness. Patient can see close up. Eyeball is too long. H52.10 Myopia, unspecified eye H52.11 Myopia, right eye H52.12 Myopia, left eye H52.13 Myopia, bilateral EyeCodingForum.com 67

68 Presbyopia Inability to see close up (reading, over 40) H52.4 Presbyopia [No Laterality] It may be confusing to memorize which conditions have laterality and which do not. Your providers may want to document laterality for all conditions and then the coder will report the proper ICD 10 code. Never add a digit for laterality if one does not already exist. EyeCodingForum.com 68

69 Other Refractive Conditions Anisometropia (antimetropia): a condition in which the two eyes have unequal refractive power. Gross anisometropia is the difference of more than 2 diopters between the eyes. Aniseikonia (aneisokonia, anisoeikonia): a defect of binocular vision in which the two retinal images of an object differ in perceived size. H52.31 Anisometropia [No Laterality] H52.32 Aniseikonia [No Laterality] EyeCodingForum.com 69

70 H52.2 **: Astigmatism Regular astigmatism: principal meridians are perpendicular. Irregular astigmatism: principal meridians are not perpendicular. H Unspecified astigmatism, right eye [Laterality] H Irregular astigmatism, right eye [Laterality] H Regular astigmatism, right eye [Laterality] EyeCodingForum.com 70

71 Ophthalmoplegia Ophthalmoplegia (Ophthalmoparesis) or ophthalmoplegia refers to weakness or paralysis of one or more extraocular muscles which are responsible for eye movements. It is a physical finding in certain neurologic illnesses. Two types, external and internal. External is a medical diagnosis code. Internal is a refraction diagnosis code. See next slide for external codes. EyeCodingForum.com 71

72 Ophthalmoplegia Note how a zero (fifth digit) indicates an unspecified eye (exception). H49.30 Total (external) ophthalmoplegia, unspecified eye H49.31 Total (external) ophthalmoplegia, right eye H49.32 Total (external) ophthalmoplegia, left eye H49.33 Total (external) ophthalmoplegia, bilateral Progressive external ophthalmoplegia, unspecified eye H49.40 H49.41 Progressive external ophthalmoplegia, right eye H49.42 Progressive external ophthalmoplegia, left eye H49.43 Progressive external ophthalmoplegia, bilateral EyeCodingForum.com 72

73 H52.5**: Ophthalmoplegia and Accommodation Disorders Internal ophthalmoplegia is characterized by paresis of ciliary body with loss of power of accommodation and pupil dilation because of lesions of ciliary ganglion. Paresis: a weakness of voluntary movement. All these codes have laterality (1,2,3,9) options. H Internal ophthalmoplegia (complete) (total), right eye H Paresis of accommodation, right eye H Spasm of accommodation, right eye EyeCodingForum.com 73

74 Other Common Conditions Diabetes, controlled (no hyperglycemia/hypoglycemia) E109: Type 1 diabetes mellitus without complications E119: Type 2 diabetes mellitus without complications Many medical carriers will pay for an office visit linked to DM Type 1/2 without any manifestations as well as some headache codes. Headache codes are covered in more detail in the sequential review of codes. EyeCodingForum.com 74

75 Headaches ICD 9 code 784.0, headache, becomes either: G44.1: vascular headache (NEC) or R51: headache I recommend not reporting either code. At the very least report a tension or migraine headache. Before you can do that you must ask questions and document more specifically. Intractable headache means it just won t go away and is not responding to standard medications and therapies for headaches. Status migrainosus refers to any migraine that persists longer than 72 hours. These apply to migraine, cluster, post traumatic, and other types of headaches not just migraines. EyeCodingForum.com 75

76 Types of Headaches Tension headaches (G44.2**) are the most common and due to muscle tension and stress. [unspecified, episodic, and chronic) Migraine headaches (G43.***) are due to a multitude of reasons and divided into common, classic, cluster, and complicated. This is not how ICD 10 organizes them, however. Eye symptoms include geometric shapes, flashbulbs, jagged lines, heat wavers, sparkling, watery images, and Swiss cheese patterns. Per ICD 10, G43.*** are migraine headaches; G44.*** includes everything else. EyeCodingForum.com 76

77 Family and Personal History Codes Report a family history code for those patients with a refraction Dx and a family history of eye disease; it s proper coding. Z82.1 Family history of blindness and visual loss Z Family history of glaucoma Z Family history of other specified eye disorder Z94.7 Corneal transplant status Z Personal history of malignant neoplasm of eye Personal history of (corrected) congenital Z malformations of eye EyeCodingForum.com 77

78 More Family History and Status Codes I do not know of any medical carriers that pay an office visit linked to a history code. Visions Plans are entirely different and most pay for a routine vision exam regardless of ICD 10 code. EyeCodingForum.com 78

79 What is GEMS? The General Equivalence Mappings (GEMS) tml GEMS is a tool that can be used to convert data from ICD 9 CM to ICD 10 CM/PCS and vice versa. Forward mapping or a crosswalk: Mapping from ICD 9 CM codes to ICD 10 CM/PCS codes. Backward mapping: Mapping from ICD 10 CM/PCS codes back to ICD 9 CM codes. GEMs is a comprehensive translation dictionary that can be used to accurately and effectively translate ICD 9 CM based data. GEMS does not account for inaccurate original ICD 9 codes, acronyms, expanded specificity, and ICD 9 codes with no crosswalk. GEMs is not a substitute for professional expertise and learning how to use the ICD 10 codes. EyeCodingForum.com 79

80 GEMS resources CMS has a webpage and all the resources are available for free. But accessing them and using the files takes some work. ICD 10 CM and GEMs.html Instructions and text files are provided, but knowledge of databases or spreadsheets plus coding conventions would be necessary to make full use of them. You will find numerous ICD 10 lookup programs on the Internet. Most will have a per code GEMS conversion routine. EyeCodingForum.com 80

81 GEMS Crosswalk The following examples are a GEMS crosswalk from ICD 9 to ICD 10. While many ICD 10 codes are exact one to one crosswalks, others are not. Different terms for the same disease, acronyms, expanded codes, and multiple codes (code also, code additional, and code first) are what makes the ICD 10 transition challenging. Finally, the greatest challenge is the dramatic increase in the number of codes. In my example, 22 ICD 9 codes expand to ICD 10 codes. EyeCodingForum.com 81

82 Simple GEMS conversion (ICD 9) Rank ICD 9 Description Regular Astigmatism Myopia Presbyopia Hypermetropia Senile nuclear sclerosis Ocular hypertension Cortical senile cataract Primary open angle glaucoma Blepharitis unspecified Benign neoplasm of retina Acute conjunctivitis unspecified Conjunctival hemorrhage Hordeolum externum Top 27 code list from a typical clinic. EyeCodingForum.com 82

83 Simple GEMS conversion Rank ICD 9 Description Diabetes mellitus without complication type II or Top 27 code list from a typical clinic unspecified type not stated as uncontrolled T Posterior subcapsular polar senile cataract Tear film insufficiency unspecified Macular degeneration (senile) of retina unspecified Drusen (degenerative) of retina Preglaucoma unspecified Anatomical narrow angle borderline glaucoma Open angle glaucoma unspecified Chronic conjunctivitis unspecified The example on the next two slides is a simple GEMS mapping. Only the stage codes are expanded. EyeCodingForum.com 83

84 GEMS ICD 10 Crosswalk (1 of 2) ICD10 H52229 H5213 H524 H5203 H2510 H40059 H25019 H4011X3 H4011X0 H4011X2 H4011X4 H4011X1 H01009 D3120 Common description Astigmatism, Regular, unsp eye Myopia, bilat Presbyopia Hypermetropia, bilat Cat, a/r nuclear unsp eye hypertension, Ocular unsp eye Cat, Cortical a/r unsp eye Glauc, POAG, severe stage Glauc, POAG, stage unsp Glauc, POAG, moderate stage Glauc, POAG, indeterminate stage Glauc, POAG, mild stage Blepharitis, unsp unsp eye, unsp eyelid Bngn neoplsm Unsp retina EyeCodingForum.com 84

85 GEMS ICD 10 Crosswalk (2 of 2) ICD10 H1033 H1133 H00019 E119 H25049 H04129 H3530 H35369 H40009 H40039 H4010X3 H4010X0 H4010X2 H4010X4 H4010X1 H10409 Common description Conjunct, unsp acute bilat Conjunctival hemorrhage, bilat Hordeolum ext unsp eye, unsp eyelid DM T2 w/o complications Cat, Post subc polar a/r unsp eye Dry eye syndr of unsp lacr gl Macular degen,unsp Drusen (degen) of macula, unsp eye Preglaucoma, unsp, unsp eye Glauc, Anat narrow/ angle, unsp eye Glauc, unsp O A, sev st Glauc, unsp O A, stage unsp Glauc, unsp O A, mod st Glauc, unsp O A, ind st Glauc, unsp O A, mild stage Conjunct, unsp chron unsp eye EyeCodingForum.com 85

86 Glaucoma Glaucoma Suspect: Laterality Only. No stage. All four codes are listed. This is a six digit code. H Preglaucoma, unspecified, right eye H Preglaucoma, unspecified, left eye H Preglaucoma, unspecified, bilateral H Preglaucoma, unspecified, unspecified eye EyeCodingForum.com 86

87 ICD 9 Glaucoma Stage Codes In ICD 9, report both the glaucoma type and a separate stage code, below, when appropriate. ICD-9 Stages ICD glaucoma stage, unspec glaucoma stage, mild glaucoma stage, moderate glaucoma stage, severe glaucoma stage, indeterminate stage 4 EyeCodingForum.com 87

88 ICD 10 Glaucoma Stage Codes Stage codes will not be reported separately and in addition to the primary glaucoma codes. The codes are combined, and ICD 10 Glaucoma stage codes will now be a seventh digit character. Note there is no laterality for POAG below. The seventh digit stage options are 0, 1, 2, 3 and 4. H40.11X0 Primary open angle glaucoma, stage unspecified H40.11X1 Primary open angle glaucoma, mild stage H40.11X2 Primary open angle glaucoma, moderate stage H40.11X3 Primary open angle glaucoma, severe stage H40.11X4 Primary open angle glaucoma, indeterminate stage EyeCodingForum.com 88

89 GEMS Crosswalk Pseudoexfoliation glaucoma Pseudoexfoliation syndrome is a systemic disorder in which a flaky, dandruff like material peels off the outer layer of the lens within the eye. Worldwide, it is a common cause of secondary glaucoma. H Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage ICD 9: Pseudoexfoliation glaucoma and ICD 9: Severe stage glaucoma [two codes] ICD 10 Eye Code: Sixth digit: (1,2,3,9) Laterality (Right, Left, Bilateral and unspecified. Seventh digit: (0,1,2,3,4) Glaucoma stage code EyeCodingForum.com 89

90 Pseudoexfoliation glaucoma (20 codes) 1 H Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified 2 H Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage 3 H Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage 4 H Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage 5 H Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage 6 H Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified 7 H Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage 8 H Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage 9 H Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage 10 H Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage 11 H Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified 12 H Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage 13 H Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage 14 H Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage 15 H Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage 16 H Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, stage unspecified 17 H Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage 18 H Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, moderate stage 19 H Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, severe stage 20 H Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate EyeCodingForum.com 90

91 Macula and ARMD ICD-9 Description ICD-10 code and description ARMD dry H35.31 ARMD dry [No Laterality] ARMD wet H35.32 ARMD wet [No Laterality] Drusen H Drusen (degenerative) of macula, right eye [Laterality] Drusen, optic disc H Drusen of the optic disc, right eye. [Laterality] EyeCodingForum.com 91

92 Diabetes Is Not Coded By Eye E10.*** Type 1 DM E11.*** Type 2 DM ICD 10 CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia. In ICD 10 ophthalmic diabetic manifestations are now one combination code instead of two codes in ICD 9. Do not document Non Insulin Dependent Diabetes Mellitus (NIDDM) or Insulin Dependent Diabetes Mellitus (IDDM). The are inaccurate and archaic. EyeCodingForum.com 92

93 Diabetes ICD 9 Fourth digit = 0, no manifestation 8 codes (typically not reported by many clinics) plus manifestation code No manifestation E11.9 Type 2 diabetes mellitus without DM II, controlled => complications E10.9 Type 1 diabetes mellitus without DM I, controlled => complications E11.65 Type 2 diabetes mellitus with DM II, uncontrolled => hyperglycemia E10.65 Type 1 diabetes mellitus with DM I, uncontrolled => hyperglycemia A1c levels usually range from 8 to 11.9 percent in uncontrolled diabetes [with hyperglycemia]. Normal = A1c level of 6.5 percent or lower. EyeCodingForum.com 93

94 Diabetes ICD 9 Fourth digit = 5, with Ophthalmic manifestation Ophthalmic Manifestation DM II, controlled DM I, controlled DM II, uncontrolled DM I, uncontrolled EyeCodingForum.com 94

95 Diabetic Retinopathy In ICD 9, two codes must be reported for diabetic retinopathies. Mild, moderate, and severe are all considered background retinopathy Diabetic retinopathy: proliferative diabetic retinopathy Diabetic retinopathy: nonproliferative diabetic retinopathy NOS Diabetic retinopathy: mild nonproliferative diabetic retinopathy Diabetic retinopathy: moderate nonproliferative diabetic retinopathy Diabetic retinopathy: severe nonproliferative diabetic retinopathy Diabetic retinopathy: diabetic macular edema In ICD 10 there are no longer two codes for diabetic retinopathies. EyeCodingForum.com 95

96 ICD 10 DM Type 1 w/ Eye Manifestation (1 of 2) E E E E E E Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema EyeCodingForum.com 96

97 ICD 10 DM Type 1 w/ Eye Manifestation (2 of 2) Type 1 diabetes mellitus with severe nonproliferative E diabetic retinopathy with macular edema Type 1 diabetes mellitus with severe nonproliferative E diabetic retinopathy without macular edema Type 1 diabetes mellitus with proliferative diabetic E retinopathy with macular edema Type 1 diabetes mellitus with proliferative diabetic E retinopathy without macular edema E10.36 Type 1 diabetes mellitus with diabetic cataract Type 1 diabetes mellitus with other diabetic ophthalmic E10.39 complication Type II follows the same pattern except E11.*** and not E10.*** EyeCodingForum.com 97

98 List with short descriptions (12 codes) ICD 10 E10311 E10319 E10321 E10329 E10331 E10339 E10341 E10349 E10351 E10359 E1036 E1039 Short Description DMT1 w/ prl db ret w/o mac edem DMT1 w/ unsp DM ret w/mac edem DMT1 w/ mld non prl db ret w/mac edem DMT1 w/ mld non prl db ret w/o mac edem DMT1 w/ unsp DM ret w/o mac edem DMT1 w/mod non prl db ret w/mac edem DMT1 w/mod non prl db ret w/o mac edem DMT1 w/sev non prl db ret w/mac edem DMT1 w/ prol db ret w/o mac edem DMT1 w/ prol db ret w/mac edem DMT1 w/ db cataract DMT1 w/ db cataract w/ oth ophth compl EyeCodingForum.com 98

99 Cataracts Age Related Senile cataract: incipient cataract Senile cataract: ant. subcapsular polar senile cataract Senile cataract: post subcapsular polar senile cataract Senile cataract: cortical senile cataract Senile cataract: nuclear sclerosis H Other age related incipient cataract, right eye H Anterior subcapsular polar agerelated cataract, right eye. H Posterior subcapsular polar agerelated cataract, right eye H Cortical age related cataract, right eye H25.11 Age related nuclear cataract, right eye Pay attention to the location in lens. Remember there are 4 ICD 10 codes for every code listed above. EyeCodingForum.com 99

100 Cataracts Juvenile Numerous types depending on age and location. These codes are not coded specifically in ICD 9 Ant Subs Post subs Cataract: infantile, juvenile, and presenile cataract: anterior subcapsular polar cataract : posterior subcapsular polar cataract H Anterior subcapsular polar infantile and juvenile cataract, right eye H Posterior subcapsular polar infantile and juvenile cataract, right eye Cortical : cortical, lamellar, or zonular cataract H Infantile and juvenile cortical, lamellar, or zonular cataract, right eye Nuclear : nuclear cataract H Infantile and juvenile nuclear cataract, right eye EyeCodingForum.com 100

101 After cataract Codes After cataracts (posterior capsular opacity) are a type of cataract that forms after surgery. It is a gradual clouding of the capsule that holds the implant in place after cataract surgery. About 20% of cataract surgeries develop an after cataract. Reasons include: 1. Cataracts that are the result of chronic steroid use. 2. Posterior subcapsular and polar cataract types. 3. Prior history of chronic iritis. 4. History of diabetes. 5. Incomplete cataract removal. EyeCodingForum.com 101

102 After cataract Codes Exception: This is an example of less specificity with ICD 10. There is no specific after cataract in ICD 10 and no obscuring vision keywords either Cataract: aftercataract: not obscuring vision Cataract: aftercataract: obscuring vision H Other secondary cataract, right eye [one code] H Other secondary cataract, right eye [same code as above] EyeCodingForum.com 102

103 Congenital Codes Examples of a unspecific ICD 10 crosswalk Congenital cataract and lens anomalies: cortical and zonular cataract Congenital cataract and lens anomalies: nuclear cataract Congenital cataract and lens anomalies: congenital cataract, unspecified Q12.0 Congenital cataract Q12.0 Congenital cataract Q12.0 Congenital cataract EyeCodingForum.com 103

104 Inflammation Codes There are nine options below for scleritis. Same sub terms in ICD scleritis, unspecified episcleritis periodica fugax H Episcleritis periodica fugax, right eye nodular episcleritis H Nodular episcleritis, right eye anterior scleritis H Anterior scleritis, right eye scleromalacia perforans H Scleromalacia perforans, right eye scleritis with corneal involvement H Scleritis with corneal involvement, right eye brawny scleritis H Brawny scleritis, right eye posterior scleritis H Posterior scleritis, right eye Scleritis and episcleritis: H Other scleritis, right eye other EyeCodingForum.com 104

105 Aphakia Crosswalk to ICD Aphakia and other disorders of lens: aphakia Aphakia and other disorders of lens: subluxation of lens Aphakia and other disorders of lens: anterior dislocation of lens Aphakia and other disorders of lens: posterior dislocation of lens Aphakia and other disorders of lens: other disorders of lens Congenital cataract and lens anomalies: congenital aphakia Congenital cataract and lens anomalies: anomalies of lens shape H27.01 aphakia, right eye H Subluxation of lens, right eye H Anterior dislocation of lens, right eye H Posterior dislocation of lens, right eye H27.8 Other specified disorders of lens Q12.3 Congenital aphakia Q12.4 Spherophakia OR Q12.8 Other congenital lens malformations EyeCodingForum.com 105

106 Entropion, Ectropion, Lagophthalmos Entropion codes stay the same except for the addition of each eyelid. Codes are not in the same order in ICD 10. Note: Only Upper Right Lid listed below. Specificity is already in ICD 9! Entropion and trichiasis H Unspecified entropion of right upper of eyelid: unspecified eyelid : senile entropion H Senile entropion of right upper eyelid : mechanical entropion H Mechanical entropion of right upper eyelid : spastic entropion H Spastic entropion of right upper eyelid : cicatricial entropion H Cicatricial entropion of right upper eyelid : trichiasis without H Trichiasis without entropion right entropion upper eyelid EyeCodingForum.com 106

107 Trauma codes S code is reported for a corneal abrasion without the foreign body. T code is reported to identify a foreign body in a specific location Corneal abrasion S05.01XA An Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter Corneal FB T15.0*X* [see next slide] EyeCodingForum.com 107

108 Foreign body, right eye T codes 1 = right eye. Seventh digit wildcard character * is the occurrence code (A, D, or S) T15.01X* T15.11X* T15.81X* T15.91X* Foreign body in cornea, right eye Foreign body in conjunctival sac, right eye Foreign body in other and multiple parts of external eye, right eye Foreign body on external eye, part unspecified, right eye EyeCodingForum.com 108

109 Common Signs and Symptoms Avoid the unspecified code if possible. Coding rule: Always report a combination code when available versus two individual codes. R11.0 Nausea R11.10 Vomiting, unspecified R11.11 Vomiting without nausea R11.2 Nausea with vomiting, unspecified EyeCodingForum.com 109

110 Common Signs and Symptoms amblyopia, unspecified H Unspecified amblyopia, right eye diplopia H53.2 diplopia [no laterality] eye pain H57.11 Ocular pain, right eye Halo, photopsia H53.19 other subjective visual disturbances (halo) subj visual disturbance H53.10 Unspecified subjective visual disturbances sudden visual loss H Sudden visual loss, right eye transient visual loss H Transient visual loss, right eye Visual discomfort H Visual discomfort, right eye Visual distortion of shape and size H53.15 Visual distortion of shape and size [no laterality] TIA G45.9 TIA EyeCodingForum.com 110

111 Other visual signs/symptoms PVD is not listed in the ICD 9 or ICD 10 manual Other vitreous opacities H Other vitreous opacities, right [Floaters] eye [Crosswalk, floaters] retinal tear H Horseshoe tear of retina without detachment, right eye Disorders of vitreous body: H Vitreous degeneration, right eye vitreous degeneration [Posterior Vitreous Detachment (PVD)] [PVD] Retinal defects w/o H Round hole, right eye detachment: round hole of retina w/o detachment EyeCodingForum.com 111

112 Miscellaneous Codes Dry Eye Syndrome is now listed in ICD 10 A choroidal nevus is a benign neoplasm Blepharitis H Ulcerative blepharitis right upper eyelid conjunctivitis H10.44 Vernal conjunctivitis tear film insufficiency, H Dry eye syndrome of right lacrimal gland hypotony [Reduced H Primary hypotony of right eye tension or pressure] migraine headache G Migr w/ aura, not intr, w/o S.M papilledema H47.11 papilledema choroidal nevus D31.31 Benign neoplasm of right choroid EyeCodingForum.com 112

113 ICD 9 Screening Codes Report a screening for current long term use of a high risk drug with V Report V67.51 for an exam following completed treatment with high risk medication NEC. Report for rheumatoid arthritis, unspecified. Always report both; link to both, and if the carrier does not pay on the V code above, link to the rheumatoid arthritis code first (or only link to the disease code above). Once an adverse effect is found for Hydrochlorquine sulfate (Plaquenil), the ICD 9 code is: E This code is specifically for this substance. EyeCodingForum.com 113

114 ICD 10 Screening Codes Report Z for current long term Plaquenil use for rheumatoid arthritis (LT use). Report Z09 for an exam following completed treatment with high risk medication NEC. Report M06.9 for rheumatoid arthritis, unspecified. Always report both; link to both, and if the carrier does not pay on the Z code, link to the M code first (or only link to the M code above). Once an adverse effect is found for Hydrochlorquine sulfate (Plaquenil), the ICD 10 code is: T37.2X5A. Includes...Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter. Note there are the encounter codes (XA, XD and XS) Initial, Subsequent and Sequela. EyeCodingForum.com 114

115 Adverse Effect [5]: Plaquenil T37.2X1* T37.2X2* T37.2X3* T37.2X4* T37.2X5* T37.2X6* Poisoning by antimalarials and drugs acting on other blood protozoa, accidental (unintentional) Poisoning by antimalarials and drugs acting on other blood protozoa, intentional self harm Poisoning by antimalarials and drugs acting on other blood protozoa, assault Poisoning by antimalarials and drugs acting on other blood protozoa, undeter Adverse effect of antimalarials and drugs acting on other blood protozoa Underdosing of antimalarials and drugs acting on other blood protozoa These are often called poisoning codes. The Underdosing term and concept is new to ICD 10. * Represents the occurrence codes: A, D or S EyeCodingForum.com 115

116 Introduction to ICD 10 for Eyecare That s a lot of information for an Introduction! In this course we will review ICD 10 codes of over 100 diseases and conditions sequentially and in depth. In addition to specifically eye conditions we will review many associated conditions. While there is some duplication, that is a good thing as there are numerous new concepts that must be learned and memorized. EyeCodingForum.com 116

117 Introduction to ICD 10 coding Jeffrey Restuccio, CPC, CPC H, MBA Memphis TN (901) EyeCodingForum.com 117

118 Claim Form Examples ICD-10 for EyeCare 118 By Jeffrey Restuccio, CPC, CPC-H EyeCodingForum.com Memphis TN (901)

119 The following claim forms will illustrate First we will show the ICD-9 codes The we will discuss documentation issues Then convert to ICD-10 codes. Includes E & M codes/920x2 and 920x4 codes. Diagnostic CPT codes Modifiers 24, 25 Linking / Medical Necessity Tying it all together. 119 EyeCodingForum.com

120 Yes, there is a new claim form Effective April Note: 12 diagnosis codes per claim Diagnosis Pointer is alpha now! EyeCodingForum.com

121 Co-Management Cataract Surgery First Eye Dr. Gregory House NPI Number Use Assumption for unlisted Date: codes, 10/16/2012 co-management Relinquish and unique Date: situations 1/10/ Nuclear Cataract - Senile 10/15/ LT 1 Units 1 121

122 Co-Management Cataract Surgery ICD-10 Dr. Gregory House NPI Number Use Assumption for unlisted Date: codes, 10/16/2012 co-management Relinquish and unique Date: situations 1/10/2013 H25.12 Age-related nuclear cataract, left eye 10/15/ LT 1 Units 1 122

123 Co-Management Link the ICD-10 left eye cataract code to the left eye cataract surgery code. H25.12 Age-related nuclear cataract, left eye LT ICD-10 will not change how CPT and HCPC codes are reported. Linking will be more precise and the linking identifiers will be alphabetic characters and not numbers. 123 EyeCodingForum.com

124 RVU s 2014 (LA CA) E & M Total RVU Medicine Total RVU Exam EyeCodingForum.com 124

125 Medicare Allowable 2014 (LA CA) CF: $ E & M Total Medicine Total Exam $ $ $ $ $ $ $ $ $ $ $ $ EyeCodingForum.com 125

126 Punctal Plugs: ICD-9 NPI Number Use for unlisted codes, co-management and unique situations anat. narrow angle glaucoma DES blepharospasm DM Type II, controlled 10/15/ /15/ /15/ , 2, E E2 3 Units MOD-51 is added to second procedure on other eyelid. 126

127 Punctal Plugs: ICD-10 NPI Number H G24.5 H E A, B, D 10/15/ /15/ /15/ E1 C E2 C

128 ICD-9 to ICD-10 Conversion anat. narrow angle glaucoma (A) H anat. narrow angle glaucoma, left eye Blepharospasm (B) G24.5 Blepharospasm [no laterality] Tear Film insufficiency (DES) [C] H Dry Eye Syndrome of left lacrimal gland E1 punctal plug insertion upper left [Linked] E2 punctal plug insertion lower left [Linked] DM II, controlled (D) E11.9 DM II, w/o complications 128 EyeCodingForum.com

129 92015 and a medical Dx NPI Number Use for unlisted codes, co-management and unique situations POAG DES Senile Cataract Moderate stage 10/15/ , 4 Units 1 10/15/ , /15/ IS paid by many private medical plans if the ICD-9 code is a medical Dx and not refraction. Paid on cataract Dx. Is allowed? With MOD-25?

130 92015 and a Medical Dx: ICD-10 NPI Number Use for unlisted codes, co-management and unique situations H40.20X2 POAG moderate stage H DES of bilateral lacrimal glands H Age-Related Cataract 10/15/ /15/ /15/ Units IS paid by many private medical plans if the ICD-9 code is a medical Dx and not refraction. Paid on cataract. 130

131 92015 linked to a medical Dx 1. H40.11X2 POAG moderate stage 2. H DES of bilateral lacrimal glands 3. H anterior subcapsular polar age-related cataract, bilateral eyes Remember, the documentation comes first; converting to the ICD-10 codes and reporting is second. 131 EyeCodingForum.com

132 Corneal Abrasion & glaucoma (contacts) Use for unlisted codes, co-management and unique situations Low tension glaucoma corneal abrasion nd iritis 10/15/ /15/ /15/ Units Anterior Segment Photography is inherently bilateral 132

133 Corneal Abrasion: ICD-10 Use for unlisted codes, co-management and unique situations H Low tension glauc bilateral S05.02XA Corneal abrasion, left eye, init S05.01XA corneal abrasion, right eye, init H nd iritis, non-infect 10/15/ /15/ /15/ , Units There is no bilateral S05.**** code option. Must list each eye separately. 133

134 Corneal abrasion ICD-10 H Low tension glaucoma bilateral S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter Choose one or the other below: H Secondary infectious iridocyclitis, bilateral H Secondary noninfectious iridocyclitis, bilateral There is no S** bilateral eyelid code. You must list both. 134 EyeCodingForum.com

135 Modifier - 24 MOD- 24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period Allows the physician to report an E & M service was performed during a postoperative or global period for a reason(s) unrelated to the original procedure A patient who is being followed by her Ophthalmologist during the post-op of cataract surgery comes in for an additional visit because she has developed conjunctivitis. The conjunctivitis is unrelated to the cataract surgery and necessitated an additional visit over and above her regular post-op check-ups. The E/M code for the visit is billed to the insurance carrier with a -24 modifier and the diagnosis code used is for Acute Conjunctivitis. EyeCodingForum.com 135

136 Modifier 24: ICD Acute conjunctivitis: acute follicular Traumatic cataract: partially resolved 10/15/ EyeCodingForum.com 136

137 Modifier 24: ICD-10 H Acute conjunctivitis: acute follicular, LEFT H Traumatic cataract: partially resolved RIGHT 10/15/ EyeCodingForum.com 137

138 Modifier 24: ICD H Acute conjunctivitis: acute follicular, LEFT eye 2. H Traumatic cataract: partially resolved RIGHT eye The cataract code does not even need to be reported here. It could be omitted. 138 EyeCodingForum.com

139 Modifier - 25 Mod- 25 Significant Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service Indicates that on a day a procedure or service identified by a CPT code was performed, the patient s condition required a significant, separately identifiable E&M service above and beyond the usual preoperative and postoperative care associated with the procedure that was performed E914 E E1 1 2 A patient is seen in the office for evaluation of his glaucoma and diabetes has a metal shard embedded in his eyelid. The physician performs an expanded, problem-focused history and examination of his chronic illnesses and performs a foreign body removal of the eyelid. Note the use of the eyelid modifier (E1 = upper left) EyeCodingForum.com 139

140 Modifier 25: ICD POAG E914 FB in adnexa Other disorders of E919.3 metalworking tools eyelid: 10/15/ /15/ E1 1 2 We are missing two codes: the location of the accident and the glaucoma stage code on this form. EyeCodingForum.com 140

141 ICD-10: First code the POAG POAG need stage code Severe stage glaucoma H40.11X3 POAG severe stage [no laterality] 141 EyeCodingForum.com

142 Foreign Body Coding T15.11XA right eye[lid] (conjunctival sac) [FB eyelid], initial occurrence [this is not an eyelid code]. FB embedded T15.81XA Foreign body on other and multiple parts of external, right eye, initial occurrence. FB superficial S00.25XA would be FB superficial eye[lid] FB retained [incorrect code; in the body for a while.] H Upper left eyelid 142 EyeCodingForum.com

143 Accident Coding ICD-9 Reason: E919.3 Accidents caused by machinery: metalworking machines ICD-10 Reason: W31.1XXA Contact with metalworking machines, initial encounter ICD-9 Location: E849.3 factory ICD-10 Location: Y92.63 Factory as the place of occurrence of the external cause 143 EyeCodingForum.com

144 Eye Exam and on same day NPI Number Use for unlisted codes, co-management and unique situations V72.0 routine Vision Exam hyperopia 10/15/ /15/ Units 1 1 Bill linked to V72.0; bill linked to hyperopia. Private carrier. Not Medicare 144

145 Eye Exam and on same day: ICD-10 NPI Number Use for unlisted codes, co-management and unique situations Z01.00 Exam Eye, w/o abn H52.03 Hyperopia, bilateral 10/15/ /15/ Units 1 1 Bill linked to Z01.00; bill linked to hyperopia. Private carrier. Not Medicare 145

146 Eye Exam and on same day: ICD-10 Z01.00 Exam Eye, w/o abnormal finding H52.03 Hyperopia, bilateral 146 EyeCodingForum.com

147 Screening Plaquenil and Rheumatoid Arthritis Use Screening for unlisted for codes, High co-management Risk Drug - Plaquenil and unique situations Papilledema V58.69 High Risk Med - Plaquenil Rheumatoid arthritis Other adenoviral conjunctivitis 03/1/ /1/ , 3 03/1/ How much should you be paid for ? RVU is.78; bilateral surgery modifier = 3; 100% per eye; approx. $22.50 per eye. 147

148 Screening Plaquenil: ICD-10 New Claim Form Screening for High Risk Drug - Plaquenil H47.10 Z M06.9 B /1/ A 1 10/1/ /1/ QW D B, C Note: 12 diagnosis codes per claim Diagnosis Pointer is alpha now! Effective April

149 GEMS Crosswalk ICD-10 codes ICD 9 ICD 10 Description H47.10 Papilledema [no laterality] V58.69 Z High Risk Med - Plaquenil M06.9 Rheumatoid arthritis B30.1 Other adenoviral conjunctivitis EyeCodingForum.com 149

150 Pachymetry For conditions below, payment frequency will be no more the once every six months, bilaterally. 1. Disorders of endothelial cell function 2. Disorders of corneal thickness 3. Corneal transplantation For glaucoma, payment is once-per-lifetime. 150 EyeCodingForum.com

151 Pachymetry ABN and MOD-GA Use for unlisted codes, co-management and unique situations endothelial corneal dystrophy NPI Number 10/15/ GA 1 Units should be paid on ICD-9 code above. However, have patient sign an ABN and append GA anyway.

152 Pachymetry ICD-10 Use for unlisted codes, co-management and unique situations H18.51 endothelial corneal dystrophy NPI Number 10/15/ GA 1 Units 1 152

153 Pachymetry ICD-9: endothelial corneal dystrophy ICD-10: H18.51 endothelial corneal dystrophy [There is no laterality to this code] 153 EyeCodingForum.com

154 ICD-9 to ICD-10 Crosswalk: Pachymetry LCD Crosswalk H1811 Bullous keratopathy, rt eye H1820 Corneal edema, unspec H18461 Periph corneal degen, rt eye H1851 Endothelial corneal dystrophy H18601 Keratoconus, unspec, rt eye H18611 Keratoconus, stable, rt eye H18621 Keratoconus, unstable, rt eye V4561 Z9841 Cat extract status, right eye V4569 Z9883 Filt (vitreous) bleb aft glauc surgery status Other ICD-10 codes that are not once per lifetime 154 EyeCodingForum.com

155 92132 Anterior Segment OCT Anterior segment OCT is rapidly becoming a valuable tool for managing some glaucoma patients. Assess angle structure in glaucoma patients with narrow or suspicious angles. Ability to perform scans in the dark. Use OCT as a complement to gonioscopy. 155 EyeCodingForum.com

156 92132 Anterior Segment OCT Get an ABN waiver signed in case of denial. Append MOD-GA to the CPT code. More carriers may pay on this in Several Medicare Jurisdictions pay on it Anatomical narrow angle 156 EyeCodingForum.com

157 92132 Anterior Segment OCT ICD-9 Use for unlisted codes, co-management and unique situations Anatomical narrow angle glaucoma NPI Number 10/15/ Units is now paid by several Medicare carriers. Be sure your ICD-9 code supports medical necessity

158 92132 Anterior Segment OCT ICD-10 NPI Number Use for unlisted codes, co-management and unique situations H40.033, Anatomical narrow angle glaucoma bilateral 10/15/ Units 1 158

159 92132 Anterior Segment OCT ICD-10 Code H , Anatomical narrow angle glaucoma bilateral 159 EyeCodingForum.com

160 Summary Everyone must get involved. Conduct audits Work on documentation now. Learn the basics. Decide how codes are selected Review ICD-10 codes now and then in more detail in Aug and September. 160 EyeCodingForum.com

161 Claim Form Examples ICD-10 for EyeCare 161 By Jeffrey Restuccio, CPC, CPC-H EyeCodingForum.com Memphis TN (901)

162 ICD 10 Coding Additional Required Codes Jeffrey Restuccio, CPC, CPC H, MBA Memphis TN (901) EyeCodingForum.com 162

163 Do I have to report two codes? If the ICD 10 manual includes instructions to: Code first Code also Code additional Code the underlying cause It is considered accurate and compliant coding to report the second code. Will you be denied if you do not report it? The best answer: it depends on how strict the insurance company edits for errors. If you create a good habit of always reporting the second code when required, you should always be paid. However, not reporting the second code is flipping a coin hoping that the insurance company will not deny you. EyeCodingForum.com 163

164 Infections Use additional code Z16.* to identify resistance to drugs A54.30 Gonococcal infection, eye, unspecified A54.31 Gonococcal conjunctivitis A54.32 Gonococcal iridocyclitis A54.33 Gonococcal keratitis A54.39 Gonococcal eye infection, other EyeCodingForum.com 164

165 Resistance to codes Select Z16.* codes Z1611 Resistance to penicillins Z1621 Resistance to vancomycin Z1624 Resistance to multiple antibiotics Z1631 Resistance to antiparasitic drug(s) Z1632 Resistance to antifungal drug(s) Z1633 Resistance to antiviral drug(s) Z1639 Resistance to other specified antimicrobial drug EyeCodingForum.com 165

166 HIV Code first HIV complications of pregnancy, childbirth etc. O98.7*. Use additional code to identify manifestations of HIV (where applicable). B20 H35.81 HIV Retinal edema [Cotton wool spots] [example] [no laterality] EyeCodingForum.com 166

167 Histoplasmosis Code first AIDS (B20) Use additional code for any associated manifestations. B39 Histoplasmosis. [fungus inhaled early in life] Code manifestations endocarditis (I39) meningitis (G02) pericarditis (I32) retinitis (H32) [Ocular Histoplasmosis Syndrome] The fungus locates in the lungs and choroid. Goal is to prevent choroidal neovascularization (CNVM). EyeCodingForum.com 167

168 Diabetes Use additional code to identify insulin use Z79.4: Long Term Use Category Short Description E08.3** DM due to underlying conditions DM due to underlying condition with proliferative E08.35* diabetic retinopathy E08.9 DM due to underlying conditions w/o complications E11.3** DM T2 w/ diab retinopathy E13.3** DM, other specified with ophthalmic complications EyeCodingForum.com

169 Diabetes Use additional code to identify insulin use Z79.4: Long Term Use Category Short Description E11.36 DM T2 w/ db cataract E11.39 DM T2 w/ oth db oph cond E DM T2 w/ hypoglycemia w/out coma E11.65 DM T2 w/ hyperglycemia E11.69 DM T2 w/ other specified complications E11.9 DM T2 w/o complications EyeCodingForum.com

170 Other Diabetes Use additional code to identify manifestation (H40 H42) Does not apply to Type 1, 2, drug induced, or any other specified diabetes. E13.9 Other specified DM w/o complications EyeCodingForum.com 170

171 Metabolic Disorders E64.1 Sequelae of vitamin A deficiency* Code first condition resulting from sequela of malnutrition and other nutritional deficiencies. E83.01 Wilson's disease Code also associated Kayser Fleisher ring (H18.04*) *Examples: keratoconjunctivitis sicca, staphyloma (H15.8**), night blindness, or leukoma. EyeCodingForum.com 171

172 Metabolic Disorders, more Use additional code for associated conditions E88.40 Mitochondrial metabolic disorder, unspec MELAS syndrome (mitochondrial myopathy, E88.41 encephalopathy, lactic acidosis and stroke like episodes E88.49 Other mitochondrial metabolic disorder Kearns Sayre syndrome (KSS) (H49.81*): characterized by childhood onset of progressive external ophthalmoplegia and pigmentary degeneration of the retina. Cortical blindness (H47.6): the total or partial loss of vision in a normal appearing eye caused by damage to the brain's occipital cortex EyeCodingForum.com 172

173 Metabolic Disorders, more Code also myoclonic epilepsy (G40.3*) E88.42 MERRF syndrome [myoclonus epilepsy with ragged red fibers ] EyeCodingForum.com 173

174 Retained Foreign Body Use additional code to identify the type of retained FB (18.*) [wood, glass, metal, plastic] H02.81* Retained FB lid Retained (old) FB following penetrating wound of H05.5* unspecified orbit H44.60* Retained (old) intraocular FB,... EyeCodingForum.com 174

175 Diseases of the Orbit Code also associated bone disease H05.32* Deformity of unspecified orbit due to bone disease EyeCodingForum.com 175

176 Eye Conditions Code first (T51 T65) to identify chemical and intent H10.21* Acute toxic conjunctivitis Code also associated Wilson's disease (E83.01) H18.04* Kayser Fleischer ring Use additional code for any associated cataract (H26.21*) H20.1* Chronic iridocyclitis EyeCodingForum.com 176

177 Eye Conditions Use additional code for adverse effect (T36 T50) 5th char 5 H21.81 Floppy iris syndrome H26.3* Drug induced cataract Code first underlying condition Excludes cataract in DM H28 Cataract in diseases classified elsewhere Code first underlying disease, such as congenital toxoplasmosis (P37.1) histoplasmosis (B39.*) H32 Chorioretinal disorders in diseases classified elsewhere EyeCodingForum.com 177

178 Eye Conditions All H35.0 codes: Code also any associated Hypertension (I10.*) H35..*** Background retinopathy and retinal vascular changes Code first poisoning; Use additional code for adverse effect. H35.38* Toxic maculopathy EyeCodingForum.com 178

179 Glaucoma, Secondary Code also underlying condition [all secondary glaucoma codes] H40.3** Glaucoma, Secondary to eye trauma... H40.4** Glaucoma, Secondary to eye inflammation... Use additional code for adverse effect; identify drug, use 5th or 6th character of 5 [adverse effect] H40.5** Glaucoma, Secondary to other eye disorders... H40.6*** Glaucoma, Secondary to drugs... Code first underlying disease H42 Glaucoma in diseases classified elsewhere EyeCodingForum.com 179

180 Retained FB Use additional code to identify the type of retained FB (18.*) Wood, metal, glass, plastic H44.6** Retained (old) intraocular foreign body, magnetic Use additional code to identify nonmagnetic FB H44.7** Retained (old) intraocular foreign body, nonmagnetic EyeCodingForum.com 180

181 Eye Conditions Code first T51 T65 to identify cause H46.3 Toxic optic neuropathy Code also underlying condition H47.4* H47.51* H47.6** Disorders of optic chiasm in (due to) other disorders Disorders of visual pathways in (due to) inflammatory disorders Disorders of visual cortex Use additional code for other manifestation, such as heart block (I45.9) H49.81* Kearns Sayre syndrome EyeCodingForum.com 181

182 Alzheimers Use additional code to identify type of delirium if applicable. G30.9 Alzheimer's disease, unspecified F05 Delirium due to known physiological condition EyeCodingForum.com 182

183 Drug Induced dyskinesia and dystonia Use additional code for adverse effect (T36 T50) 5th character of 5. G24.01 Drug induced subacute dyskinesia* G24.02 Drug induced acute dystonia G24.09 Other drug induced dystonia G24.3 Spasmodic torticollis *Adverse effect of antipsychotic medication for long periods. Dyskinesia are involuntary movements. Dystonia is a neurological movement disorder. EyeCodingForum.com 183

184 Migraines with auras Code also any associated seizure (G40.*; R56.9) G43.1** Migraine with aura... EyeCodingForum.com 184

185 Migraine, Persistent Code also type of cerebral infarction (I63.*) G43.6** Migraine Persistent aura w/ cerebral infarction EyeCodingForum.com 185

186 Inflammatory Polyarthopathies Code also any associated underlying condition such as Crohns disease (K50.*) or ulcerative colitis (K51.*) M08.*** Juvenile arthritis Use additional code to identify disorders of iris and ciliary body in diseases classified elsewhere (H22.*) M1A.**** Chronic gout M10.*** Gout EyeCodingForum.com 186

187 Summary Coding from the manual is always recommended. Always follow the second code instructions in ICD 10. Most of these requirements already exist in ICD 9. Start now and audit often. If you use a fee ticket, cheat sheet, or lookup program, be sure to follow code also, code first, code additional, and code primary instructions. EyeCodingForum.com 187

188 ICD 10 Coding Additional Required Codes Jeffrey Restuccio, CPC, CPC H, MBA Memphis TN (901) EyeCodingForum.com 188

189 ICD 10 coding for Eyecare Comprehensive Coding Training Sequential Code Review Jeffrey Restuccio, CPC, CPC H, MBA Memphis TN (901) EyeCodingForum.com 189

190 This is a code by code review of ICD 10 codes for Eyecare Since an x is now a valid character within ICD 10 we can no longer use xxx as a wildcard. I will use * when there are multiple options. Most codes will default to the right eye only in this course. While the majority of ICD 10 codes cross walk perfectly, understand that both ICD 9 and ICD 10 are international and therefore many ICD 10 disease descriptions often do not reflect commonly used terminology in the United States. EyeCodingForum.com 190

191 Will using an unspecified diagnosis code impact my reimbursement? As a certified coder and auditor it is my obligation to instruct everyone on proper and accurate coding rules and guidelines. Submitting all relevant codes to the highest level of specificity is the job of every provider. For one, it tells the complete story of the encounter. For a patient with a headache, a cluster headache, intractable, is more informative than headache, NOS Entropion, right upper eyelid, mechanical, is more informative than entropion, unspecified, unknown eye, and unknown eyelid. For an injury, adding that the foreign body occurred in their wood shop in their garage on a grinding wheel adds more information when you identify the nature of the encounter. EyeCodingForum.com 191

192 More on Reimbursement Converting current unspecific ICD 9 codes to an unspecific ICD 10 fee ticket or cheat sheet is not recommended: Some carriers may reject an unspecific Dx. It s always best to get it right the first time than try to fix it later. Create good documentation habits: omitting codes and unspecified codes look bad during an audit if the medical document is unspecific. Unspecific codes in the documentation or reported suggest you don t know what is wrong with the patient. If you know the specific differential diagnosis but fail to document and report it, that is the same as not knowing. EyeCodingForum.com 192

193 Eyecare H codes (H10 H16) 1 H00.*** Conditions of the eyelid 2 H01.*** Conditions of the eyelid 3 H02.*** Entropions 4 H04.*** Conditions of the lacrimal system 5 H05.*** Conditions of the orbit 6 H10.*** Conjunctival conditions 7 H15.*** Conditions of the sclera 8 H16.*** Keratoconjunctivitis ICD 10 starts with the external ocular adnexa. EyeCodingForum.com 193

194 Eyecare H codes (H17 H30) 9 H17.*** Conditions of the cornea 10 H18.*** Keratopathies 11 H20.*** Conditions of the iris 12 H21.*** Disorders of iris and ciliary body 13 H25.*** Cataracts 14 H26.*** Cataracts, other 15 H27.** Conditions of the lens 16 H30.** Chorioretinal conditions Moves to the anterior chamber. EyeCodingForum.com 194

195 Eyecare H codes (H31 H44) 17 H31.*** Conditions of the Choroid 18 H33.** Conditions of the retina 19 H34.*** Retinal occlusions 20 H35.*** Retinal changes 21 H40.*** Glaucoma 22 H43.*** Vitreous codes 23 H44.*** Disorders of vitreous body and globe 24 H44.6** Unspecified retained (old) intraocular foreign bodies Retinal and vitreous conditions. EyeCodingForum.com 195

196 Eyecare H codes (H47 H59) 25 H46.*** Irritations of anterior chamber hypotony 26 H47.*** Neuropathies 27 H51.*** Convergence disorders 28 H52.*** Refraction Disorders 29 H53.*** Amblyopia/visual field defects 30 H54.*** Blindness 31 H55.*** Nystagmus 32 H57.*** Pupillary Disorders and ocular pain 33 H59.*** Disorders following Surgery Finishes with neuropathies, refraction disorders, visual field defects, and miscellaneous conditions. EyeCodingForum.com 196

197 ICD 10 H Code Detail We will now go into detail on the specific eye diseases and conditions. After the H section we will discuss other codes related to Eyecare. After we review all the code groups we will discuss actual clinical examples in the afternoon. EyeCodingForum.com 197

198 H00.***: Conditions of the eyelid A hordeolum (stye) is a small infection of the glands in the eye. The codes should be documented and reported by eyelid. A chalazion is a cyst in the eyelid that is caused by inflammation of a blocked, oil producing meibomian gland. H Hordeolum externum right upper eyelid H Hordeolum internum right upper eyelid H Abscess of right upper eyelid H00.11 Chalazion right upper eyelid They are both lumps along the edge of an eyelid. When a stye does not heal, it can become a chalazion. EyeCodingForum.com 198

199 H01.***: Conditions of the eyelid Xeroderma: is dry skin of the eyelid. Do not confuse with xanthelasma, (H02.6*) is a flat, yellowish deposit of fat on the eyelid. Note all codes below are listed with right upper eyelid (.**1) Unspecified blepharitis unspecified eye, right upper H eyelid H Ulcerative blepharitis right eye, right upper eyelid H Allergic dermatitis of right eye, right upper eyelid Discoid lupus erythematosus of right eye, right upper H eyelid H Eczematous dermatitis of right eye, right upper eyelid H Xeroderma of right eye, right upper eyelid EyeCodingForum.com 199

200 H01.02*: Conditions of the eyelid Squamous blepharitis: a kind of nonulcerative blepharitis in which the edge of the eyelid is covered with small white or gray scales. It may be associated with dandruff. It is not cancer and should not be confused with: Squamous cell carcinoma, a cancer of a kind of epithelial cell, the squamous cell; these cells are the main part of the epidermis of the skin. H Squamous blepharitis right upper eyelid EyeCodingForum.com 200

201 H02.***: Entropions Cicatricial entropion: A scar left by the formation of new connective tissue over a healing sore or wound. Trichiasis is an ingrown eyelash. There is a one to one ICD 9 to ICD 10 crosswalk. However, the codes are in a different order. H Cicatricial entropion of right eye, upper right eyelid H Mechanical entropion of right eye, upper right eyelid H Senile entropion of right eye, upper right eyelid H Spastic entropion of right eye, upper right eyelid H Trichiasis without entropian right eye, upper right eyelid EyeCodingForum.com 201

202 H04.***: Conditions of the lacrimal system Lacrimal glands are not indicated by punctum as in inferior and superior (eyelid ICD 10 codes). They are right or left. Dacryops: a watery state of the eye. A distention of a lacrimal duct by contained fluid. H Chronic dacryoadenitis, right lacrimal gland H Dacryops of right lacrimal gland H Dry eye syndrome of right lacrimal gland H Lacrimal cyst, right lacrimal gland H Primary lacrimal gland atrophy, right lacrimal gland H Secondary lacrimal gland atrophy, right lacrimal gland H Lacrimal gland dislocation, right lacrimal gland EyeCodingForum.com 202

203 H04.***: Conditions of the lacrimal system Epiphora is excess tearing. Granuloma is a collection of immune cells known as macrophages [on next slide]. H Unspecified epiphora, right lacrimal gland Epiphora due to excess lacrimation, right lacrimal H gland (ICD 9: ) Epiphora due to insufficient drainage, right lacrimal H gland (ICD 9: ) H Unspecified dacryocystitis of right lacrimal passage H Phlegmonous dacryocystitis of right lacrimal passage H Acute dacryocystitis of right lacrimal passage H Acute lacrimal canaliculitis of right lacrimal passage EyeCodingForum.com 203

204 H04.***: Conditions of the lacrimal system All are right lacrimal passage. Remember lacrimal is right or left. H Chronic dacryocystitis of right lacrimal passage H Chronic lacrimal canaliculitis of right lacrimal passage H Chronic lacrimal mucocele of right lacrimal passage H Dacryolith of right lacrimal passage H Eversion of right lacrimal punctum H Neonatal obstruction of right nasolacrimal duct H Stenosis of right lacrimal canaliculi [narrowing] H Acquired stenosis of right nasolacrimal duct H Stenosis of right lacrimal punctum H Stenosis of right lacrimal sac H Lacrimal fistula right lacrimal passage H Granuloma of right lacrimal passage EyeCodingForum.com 204

205 H05.***: Conditions of the orbit H Cellulitis of right orbit H Osteomyelitis of right orbit H Periostitis of right orbit H Tenonitis of right orbit H Granuloma of right orbit H Orbital myositis, right orbit H Displacement (lateral) of globe, right eye H Edema of right orbit H Hemorrhage of right orbit H Constant exophthalmos, right eye H Intermittent exophthalmos, right eye Exophthalmos is a bulging of the eye anteriorly out of the orbit. It is also called proptosis. EyeCodingForum.com 205

206 H05.***: Conditions of the orbit H Pulsating exophthalmos, right eye H Atrophy of right orbit H Deformity of right orbit due to bone disease [Code Also] H Deformity of right orbit due to trauma or surgery H Enlargement of right orbit Exostosis of right orbit [rare, a benign outgrowth from a bone] H H Unspecified enophthalmos, right eye [bulging posteriorly] H Enophthalmos due to atrophy of orbital tissue, right eye H Enophthalmos due to trauma or surgery, right eye Retained (old) foreign body following penetrating wound of right orbit H05.51 H Cyst of right orbit H Myopathy of extraocular muscles, right orbit EyeCodingForum.com 206

207 H10.***: Conjunctival conditions H Acute follicular conjunctivitis, right eye H Other mucopurulent conjunctivitis, right eye H10.11 Acute atopic conjunctivitis, right eye H Acute toxic conjunctivitis, right eye H Pseudomembranous conjunctivitis, right eye H Serous conjunctivitis, except viral, right eye H10.31 Unspecified acute conjunctivitis, right eye H Unspecified chronic conjunctivitis, right eye Remember, there will be four ICD 10 codes for every one above, RT, LT, bilateral and unspecified. Be specific whenever possible. EyeCodingForum.com 207

208 H10.***: Conjunctival conditions Pingueculitis is an inflammed pinguecula [ H11.151]. H Chronic giant papillary conjunctivitis (GPC), right eye H Simple chronic conjunctivitis, right eye H Chronic follicular conjunctivitis, right eye H Unspecified blepharoconjunctivitis, right eye H Ligneous conjunctivitis, right eye H Angular blepharoconjunctivitis, right eye H Contact blepharoconjunctivitis, right eye H Pingueculitis, right eye EyeCodingForum.com 208

209 H11.***: Conditions of the conjunctiva Pterygium: (aka surfer s eye) is a benign growth of the conjunctiva that usually grows slowly. They tend to move toward the center of the eye. A pterygium is often preceded by a pinguecula. Most providers document them as temporal or nasal. ICD 10 does not use those terms. H Unspecified pterygium of right eye H Amyloid pterygium of right eye H Central pterygium of right eye H Double pterygium of right eye H Peripheral pterygium, stationary, right eye H Peripheral pterygium, progressive, right eye H Recurrent pterygium of right eye EyeCodingForum.com 209

210 H11.***: Conditions of the conjunctiva Pinguecula is a common, non cancerous growth of the clear, thin tissue (conjunctiva) of the eye. It is a yellow white deposit on the conjunctiva adjacent to the limbus (the junction between the cornea and sclera). Symblepharon is a partial/complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball. H Conjunctival deposits, right eye H Conjunctival concretions, right eye H Conjunctival pigmentations, right eye H Conjunctival xerosis, unspecified, right eye H Pinguecula, right eye [Note pingueculitis was H10.***] H Conjunctival adhesions and strands (localized), right eye H Conjunctival granuloma, right eye H Symblepharon, right eye H Scarring of conjunctiva, right eye EyeCodingForum.com 210

211 H11.***: Conditions of the conjunctiva Conjunctivochalasis: a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eye lid margin. H11.31 Conjunctival hemorrhage, right eye H Vascular abnormalities of conjunctiva, right eye H Conjunctival edema, right eye H Conjunctival hyperemia, right eye H Conjunctival cysts, right eye H Pseudopterygium of conjunctiva, right eye H Conjunctivochalasis, right eye EyeCodingForum.com 211

212 H15.***: Conditions of the sclera These codes crosswalk almost exactly from ICD 9. H Unspecified scleritis, right eye H Anterior scleritis, right eye H Brawny scleritis, right eye H Posterior scleritis, right eye H Scleritis with corneal involvement, right eye Brawny scleritis is a gelatinous appearing swelling surrounding, and with a tendency to involve the periphery of the cornea. EyeCodingForum.com 212

213 H15.***: Conditions of the sclera Scleromalacia perforans, also known as necrotizing scleritis, is the most severe form of scleritis, sometimes leading to loss of the eye. The condition is often associated with systemic disease and involvement of multiple organs. [H15.05*] These codes crosswalk almost exactly from ICD 9. Scleromalacia perforans, right eye [does not include the H term scleritis in the definition] H Other scleritis, right eye H Unspecified episcleritis, right eye H Episcleritis periodica fugax, right eye H Nodular episcleritis, right eye EyeCodingForum.com 213

214 H16.***: Keratoconjunctivitis Kerato means cornea. H Unspecified keratoconjunctivitis, right eye [Please Avoid] H Exposure keratoconjunctivitis, right eye Keratoconjunctivitis sicca, not specified as Sjogren's, right H eye H Neurotrophic keratoconjunctivitis, right eye H Phlyctenular keratoconjunctivitis, right eye Vernal keratoconjunctivitis, with limbar and corneal H involvement, right eye H Other keratoconjunctivitis, right eye EyeCodingForum.com 214

215 Keratitis Contact lens related keratitis often causes superficial punctate keratitis (aka punctate erosive keratopathy, punctate epithelial erosions or Thygeson's superficial punctate keratopathy H Unspecified superficial keratitis, right eye [370.20] H Macular keratitis, right eye H Filamentary keratitis, right eye H Photokeratitis, right eye H Punctate keratitis, right eye [370.21] EyeCodingForum.com 215

216 Keratitis Interstitial is the space between cells. H Unspecified interstitial keratitis, right eye H Diffuse interstitial keratitis, right eye H Sclerosing keratitis, right eye H Other interstitial and deep keratitis, right eye EyeCodingForum.com 216

217 Keratitis In addition to the specific keratitis H codes the cause should also be documented and reported. Note these are codes from the A and B section of the ICD 10 manual. This is not a complete list. A18.51 Tuberculous episcleritis A18.52 Tuberculous keratitis A50.31 Late congenital syphilitic interstitial keratitis A54.33 Gonococcal keratitis B00.52 Herpesviral keratitis B01.81 Varicella keratitis B02.33 Zoster keratitis B05.81 Measles keratitis and keratoconjunctivitis EyeCodingForum.com 217

218 H17.***: Conditions of the cornea Adherent leukoma/leucoma: a white tumor of the cornea enclosing a prolapsed adherent iris. H17.01 Adherent leukoma, right eye H17.11 Central corneal opacity, right eye H Minor opacity of cornea, right eye H Peripheral opacity of cornea, right eye EyeCodingForum.com 218

219 Corneal Scars (H17, H18) ICD 9 Crosswalk is in different order. ICD 10 ICD 9 H Corneal scars and opacities: corneal opacity, unspecified H Corneal scars and opacities: minor opacity of cornea H Corneal scars and opacities: peripheral opacity of cornea H Corneal scars and opacities: central opacity of cornea H Corneal scars and opacities: adherent leucoma EyeCodingForum.com 219

220 Phthisical Scars (H17, Q13) Phthisis and Phthisical [thahy sis] (a wasting away) refers to an eye that has shrunk down due to loss of its fluid. This is an acquired condition that is caused by a disease, trauma or possibly surgery. (Acquired condition would indicate that you had a normal size eye prior to this event.) Also, if the globe is microphthalmic, it would indicate that it is a congenital problem. It never developed to full size. EyeCodingForum.com 220

221 Phthisical Scars (H17, Q13) ICD 9 Crosswalk is not one to one. ICD 10 ICD Corneal scars and opacities: phthisical cornea [phthisical is not in the ICD 10] H17.89 Other corneal scars and opacities [use for phthisical cornea above] H17.10 Central corneal opacity, unspecified eye [Avoid] H17.13 Central corneal opacity, bilateral Q13.3 Congenital corneal opacity [use for Congenital Form] EyeCodingForum.com 221

222 H18.***: Keratopathies H Unspecified corneal deposit, right eye H Anterior corneal pigmentations, right eye H Argentous corneal deposits, right eye H Corneal deposits in metabolic disorders, right eye H Kayser Fleischer ring, right eye H Posterior corneal pigmentations, right eye H Stromal corneal pigmentations, right eye Argentous: containing univalent silver as argentous chloride or AgCl. EyeCodingForum.com 222

223 H18.***: Keratopathies H18.11 Bullous keratopathy, right eye H Corneal edema secondary to contact lens, right eye H Idiopathic corneal edema, right eye H Secondary corneal edema, right eye H Folds and rupture in Bowman's membrane, right eye H Folds in Descemet's membrane, right eye H Rupture in Descemet's membrane, right eye The cornea has five layers (anterior to posterior): 1. Epithelium 2. Bowman s layer. 3. Stroma 4. Descemet membrane 5. Endothelium EyeCodingForum.com 223

224 H18.***: Keratopathies H Arcus senilis, right eye H Band keratopathy, right eye H Keratomalacia, right eye H Nodular corneal degeneration, right eye H Peripheral corneal degeneration, right eye Arcus senilis is a white, gray, or blue opaque ring in the corneal margin (peripheral corneal opacity), or white ring in front of the periphery of the iris. Common in the elderly and often a result cholesterol deposits. Keratomalacia is a softening, drying, or ulceration. EyeCodingForum.com 224

225 H18.***: Keratopathies H18.51Endothelial corneal dystrophy Fuchs endothelial dystrophy (FED) is a degenerative disease of the corneal endothelium with accumulation of focal outgrowths called guttate (drops) and thickening of Descemet s membrane, leading to corneal edema and loss of vision. EyeCodingForum.com 225

226 H18.***: Keratopathies Keratoconus report stable and unstable H Keratoconus, unspecified, right eye H Keratoconus, stable, right eye H Keratoconus, unstable, right eye H Corneal ectasia, right eye H Corneal staphyloma, right eye Keratoconus is an abnormal cone shaped protrusion of the cornea of the eye often creating irregular astigmatism. Progressive or nonprogressive? Mild/moderate keratoconus (Amsler stage 1 or 2) and stable corneas. Advanced keratoconus (Amsler stage 3 or 4) and unstable corneas. EyeCodingForum.com 226

227 H18.***: Keratopathies Descemetocele is an ophthalmic condition characterized by thinning of the stroma of the cornea (of the eye) to such extent that Descemet's membrane is the only layer maintaining the integrity of the eyeball. H Descemetocele, right eye H Other corneal deformities, right eye H Anesthesia and hypoesthesia of cornea, right eye H Corneal disorder due to contact lens, right eye H Recurrent erosion of cornea, right eye H Other specified disorders of cornea, right eye EyeCodingForum.com 227

228 H20.***: Conditions of the iris Iridocyclitis or Iritis? The term iritis is not found in ICD 10. Anterior uveitis includes iridocyclitis and iritis. Iritis is the inflammation of the anterior chamber and iris. Iridocyclitis presents the same symptoms as iritis, but also includes inflammation in the vitreous cavity. This code applies to both. Infectious or noninfectious? If known, report the infection (A or B code). H Primary iridocyclitis, right eye H Recurrent acute iridocyclitis, right eye H Secondary infectious iridocyclitis, right eye H Secondary noninfectious iridocyclitis, right eye EyeCodingForum.com 228

229 H20.***: Conditions of the iris Hypopyon: inflammatory cells in the anterior chamber of eye, seen as yellowish exudate in lower part of anterior chamber of eye. H Hypopyon, right eye H20.11 Chronic iridocyclitis, right eye H20.21 Lens induced iridocyclitis, right eye H Fuchs' heterochromic cyclitis, right eye H Vogt Koyanagi syndrome, right eye EyeCodingForum.com 229

230 H21.***: Disorders of iris and ciliary body Hyphema: blood in the front (anterior) chamber of the eye. H21.01 Hyphema, right eye Other vascular disorders of iris and ciliary body, right H21.1X1 eye [X placeholder code is correct] H Degeneration of chamber angle, right eye H Degeneration of ciliary body, right eye H Degeneration of iris (pigmentary), right eye H Degeneration of pupillary margin, right eye H Iridoschisis, right eye H Iris atrophy (essential) (progressive), right eye H Miotic pupillary cyst, right eye EyeCodingForum.com 230

231 H21.***: Disorders of iris and ciliary body H Exudative cysts of iris or anterior chamber, right eye Implantation cysts of iris, ciliary body or anterior H chamber, right eye Parasitic cyst of iris, ciliary body or anterior chamber, H right eye H Primary cyst of pars plana, right eye H Exudative cyst of pars plana, right eye H21.41 Pupillary membranes, right eye Hydatid Cysts: describes infection with the larval stage of the cestode (or tapeworm) Echinococcus granulosus. (B67.39: Echinococcus granulosus infection, other) EyeCodingForum.com 231

232 H21.***: Disorders of iris and ciliary body Synechiae: an eye condition where the iris adheres to either: The cornea: anterior synechia The lens: posterior synechia H Unspecified adhesions of iris, right eye H Anterior synechiae (iris), right eye [to cornea] H Goniosynechiae, right eye H Iridodialysis, right eye H Posterior synechiae (iris), right eye [to lens] H Recession of chamber angle, right eye H Pupillary abnormality, right eye EyeCodingForum.com 232

233 H25.***: Age Related Cataracts The term senile cataract is not in ICD 10; it is listed as agerelated. Morgagnian type: a mature cataract in which the cortex has liquefied and the nucleus moves freely within the lens. H Cortical age related cataract, right eye H Anterior subcapsular polar age related cataract, right eye H Posterior subcapsular polar age related cataract, right eye H Other age related incipient cataract, right eye H25.11 Age related nuclear cataract, right eye H25.21 Age related cataract, morgagnian type, right eye (ICD 9 is ) H Combined forms of age related cataract, right eye [common] EyeCodingForum.com 233

234 A Whole Lotta Cataract Types Mature cataract (total). ICD converts to: H25.8* Other age related cataract Cataract (anterior cortical) (anterior polar) (black) (capsular) (central) (hypermature) senile anterior subcapsular polar combined forms cortical hypermature converts to morganian type H25.21 immature incipient EyeCodingForum.com 234

235 A Whole Lotta Cataract Types nuclear posterior subcapsular polar specified NEC subtotal (senile) congenital total (mature) (senile) congenital localized traumatic EyeCodingForum.com 235

236 Still more Cataracts black cataract see senile nuclear sclerotic cataract. blue cataract, blue dot cataract, blue punctate opacities, scattered throughout the nucleus and cortex of the lens. It is a congenital condition and does not progress or cause a reduction in vision. brown cataract, brunescent cataract, see senile nuclear sclerotic cataract. (Brunescent means developing a brownish or amber color over time. Nuclear cataracts are sometimes called brunescent.) What you do not see is dense cataract. Be sure to clarify. EyeCodingForum.com 236

237 H26.***: Cataracts, other Report the type of cataract codes These are Infantile/juvenile, by location H Unspecified infantile and juvenile cataract, right eye Infantile and juvenile cortical, lamellar, or zonular cataract, H right eye H Infantile and juvenile nuclear cataract, right eye Anterior subcapsular polar infantile and juvenile cataract, H right eye Posterior subcapsular polar infantile and juvenile cataract, H right eye EyeCodingForum.com 237

238 H26.***: Cataracts, other Traumatic cataracts occur secondary to blunt or penetrating ocular trauma. Combined forms of infantile and juvenile cataract, right H eye H Unspecified traumatic cataract, right eye H Localized traumatic opacities, right eye H Partially resolved traumatic cataract, right eye H Total traumatic cataract, right eye EyeCodingForum.com 238

239 H26.***: Cataracts, other A secondary cataract occurs from complications after cataract surgery; symptoms include hazy or blurry vision caused by posterior capsule opacity. H26.31 Drug induced cataract, right eye H Soemmering's ring, right eye H Other secondary cataract, right eye Glaucoma flecks (also known as glaukomflecken) are spots on the lens of the eye. Glaucoma flecks may be seen if an acute attack of angle closure has occurred in the past. EyeCodingForum.com 239

240 Cataract secondary to ocular disorders: glaucomatous flecks (subcapsular) Secondary glaucoma Straightforward Crosswalk/Mapping Cataract secondary to ocular disorders: cataract in inflammatory disorders Cataract secondary to ocular disorders: cataract with neovascularization H Glaucomatous flecks (subcapsular), right eye H Cataract secondary to ocular disorders (degenerative) (inflammatory) right eye H Cataract with neovascularization, right eye EyeCodingForum.com 240

241 H27.**:Conditions of the lens H27.01 Aphakia, right eye [Absence of a lens] H Subluxation of lens, right eye H Anterior dislocation of lens, right eye H Posterior dislocation of lens, right eye Z96.1 Pseudophakia [artificial lens IOL] [ICD 9: V43.1] EyeCodingForum.com 241

242 H30.**: Chorioretinal conditions H Unspecified focal chorioretinal inflammation, right eye Focal chorioretinal inflammation, juxtapapillary, right H eye Focal chorioretinal inflammation of posterior pole, right H eye H Focal chorioretinal inflammation, peripheral, right eye Focal chorioretinal inflammation [multiple kinds] are defined as a localized inflammation of the choroids and retina which includes: focal chorioretinitis, focal choroiditis, focal retinitis, and focal retinochoroiditis. EyeCodingForum.com 242

243 H30.**: Chorioretinal conditions Always report the specific location. H H H H H Focal chorioretinal inflammation, macular or paramacular, right eye Unspecified disseminated chorioretinal inflammation, right eye Disseminated chorioretinal inflammation of posterior pole, right eye Disseminated chorioretinal inflammation, peripheral right eye Disseminated chorioretinal inflammation, generalized, right eye EyeCodingForum.com 243

244 H30.**: Chorioretinal conditions Harada's disease, also called Vogt Koyanagi Harada syndrome, is an acute inflammatory, immune system disorder that typically affects bilateral eyes of middle aged adults and involves melanocyte containing organs such as the skin, ear, meninges, and eye. Acute posterior multifocal placoid pigment H epitheliopathy, right eye H30.21 Posterior cyclitis, right eye H Harada's disease, right eye H Other chorioretinal inflammations, right eye H30.91 Unspecified chorioretinal inflammation, right eye EyeCodingForum.com 244

245 H31.*** : Conditions of the Choroid Solar retinopathy is damage to the eye's retina, particularly the macula, from prolonged exposure to solar radiation or other bright light (arc welders). H Unspecified chorioretinal scars, right eye Macula scars of posterior pole (postinflammatory) H (post traumatic), right eye H Solar retinopathy, right eye H Other chorioretinal scars, right eye H Choroidal degeneration, unspecified, right eye H Age related choroidal atrophy, right eye H Diffuse secondary atrophy of choroid, right eye EyeCodingForum.com 245

246 H31.*** : Conditions of the Choroid H Unspecified choroidal hemorrhage, right eye [Avoid] H Expulsive choroidal hemorrhage, right eye H Choroidal rupture, right eye H Unspecified choroidaldetachment, right eye H Hemorrhagic choroidal detachment, right eye H Serous choroidal detachment, right eye EyeCodingForum.com 246

247 H33.**: Conditions of the retina Detachment of the retina. Unspecified retinal detachment with retinal break, right H eye H Retinal detachment with single break, right eye H Retinal detachment with multiple breaks, right eye H Retinal detachment with giant retinal tear, right eye H Retinal detachment with retinal dialysis, right eye H Total retinal detachment, right eye Unspecified retinoschisis, right eye [abnormal splitting of H the retina's neurosensory layers] H Cyst of ora serrata, right eye H Parasitic cyst of retina, right eye EyeCodingForum.com 247

248 H33.**: Conditions of the retina Detachment and breaks H Other retinoschisis and retinal cysts, right eye H33.21 Serous retinal detachment, right eye H Unspecified retinal break, right eye H Horseshoe tear of retina without detachment, right eye H Round hole, right eye H Multiple defects of retina without detachment, right eye H33.41 Traction detachment of retina, right eye EyeCodingForum.com 248

249 H34.***: Retinal occlusions These acronyms won t be in most ICD 10 lookup databases unless specifically added. H34.01 Transient retinal artery occlusion, right eye [TRAO] H34.11 Central retinal artery occlusion, right eye [CRAO] H Partial retinal artery occlusion, right eye H Retinal artery branch occlusion, right eye [BRAO] H Central retinal vein occlusion, right eye [CRVO] H Venous engorgement, right eye H Tributary (branch) retinal vein occlusion, right eye H34.*** Retinal occlusions EyeCodingForum.com 249

250 H35.***: Retinal changes H Changes in retinal vascular appearance, right eye H Exudative retinopathy, right eye H Hypertensive retinopathy, right eye H Retinal micro aneurysms, unspecified, right eye H Retinal neovascularization, unspecified, right eye H Retinal vasculitis, right eye H Retinal telangiectasis, right eye Retinal telangiectasis: (aka Coats disease and exudative retinitis), is a very rare congenital, nonhereditary eye disorder, causing full or partial blindness, characterized by abnormal development of blood vessels behind the retina. EyeCodingForum.com 250

251 H35.1**: Retinopathy of prematurity (ROP) H Retinopathy of prematurity, unspecified, right eye H Retinopathy of prematurity, stage 0, right eye H Retinopathy of prematurity, stage 1, right eye H Retinopathy of prematurity, stage 2, right eye H Retinopathy of prematurity, stage 3, right eye H Retinopathy of prematurity, stage 4, right eye H Retinopathy of prematurity, stage 5, right eye A condition affecting prematurely born babies due to oxygen therapy. EyeCodingForum.com 251

252 H35.***: Retinal changes H Retrolental fibroplasia, right eye H35.21 Other non diabetic proliferative retinopathy, right eye H Macular cyst, hole, or pseudohole, right eye H Cystoid macular degeneration, right eye Drusen (degenerative) of macula, right eye [Drusen associated with dry ARMD] H H Puckering of macula, right eye [scar tissue] H Toxic maculopathy, right eye H Lattice degeneration of retina, right eye [atrophic] H Microcystoid degeneration of retina, right eye H Paving stone degeneration of retina, right eye H Age related reticular degeneration of retina, right eye H Secondary pigmentary degeneration, right eye H Secondary vitreoretinal degeneration, right eye EyeCodingForum.com 252

253 H35.***: Retinal changes H35.61 Retinal hemorrhage, right eye H Central serous chorioretinopathy, right eye Serous detachment of retinal pigment epithelium, H right eye Hemorrhagic detachment of retinal pigment H epithelium, right eye EyeCodingForum.com 253

254 ICD 10 Glaucoma stage codes Sixth digit is right eye or 1. Seventh digit stage options are 0, 1, 2, 3 and 4. H Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified H Same as above == > mild stage H Same as above == > moderate stage H Same as above == > severe stage H Same as above == > indeterminate stage EyeCodingForum.com 254

255 Bilateral Glaucoma When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not have laterality, that is provide a code for bilateral glaucoma (i.e., subcategories H40.10, H40.11 and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage. In other words, some glaucoma codes do not have laterality. EyeCodingForum.com 255

256 H40.0**: Glaucoma Glaucoma codes: No stage code required. Codes are in order. H Preglaucoma, unspecified, right eye [glaucoma suspect] H Open angle with borderline findings, low risk, right eye H Open angle with borderline findings, high risk, right eye H Anatomical narrow angle, right eye H Steroid responder, right eye H Ocular hypertension, right eye Primary angle closure without glaucoma damage, right H eye. EyeCodingForum.com 256

257 H40.1*X*: Glaucoma Glaucoma codes: Stage code required plus X placeholder. H40.10X* Unspecified open angle glaucoma [No laterality] H40.11X* Primary Open angle Glaucoma (POAG) [No laterality] Seventh digit stage options are 0, 1, 2, 3 and 4. EyeCodingForum.com 257

258 H40.***: Glaucoma Glaucoma codes: *add a seventh digit to indicate stage. H40.121* Low tension glaucoma, right eye + Stage [20 codes] H40.131* Pigmentary glaucoma, right eye + Stage [20 codes] H40.141* Capsular glaucoma with pseudoexfoliation of lens, right eye + Stage [20 codes] H Residual stage of open angle glauc, right eye No Stage H40.20X* Unspecified primary angle closure glaucoma Stage Only H Acute angle closure glaucoma, right eye No Stage H40.221* Chronic angle closure glaucoma, right eye + Stage [20 codes] H Intermittent angle closure glaucoma, right eye, No Stage H Residual stage of angle closure glauc, right eye No Stage EyeCodingForum.com 258

259 H40.***: Secondary Glaucoma Secondary Glaucoma codes: includes laterality, a seventh digit to indicate stage plus the cause of the secondary glaucoma. H40.31X* Code underlying Glaucoma disorder. secondary to eye trauma, right eye [ + ] H40.41X* Glaucoma secondary to eye inflammation, right eye [+] H40.51X* Glaucoma secondary to other eye disorders, right eye [+] H40.61X* Glaucoma secondary to drugs, right eye [+] Glaucoma with increased episcleral venous pressure, right H eye No Stage H Hypersecretion glaucoma, right eye No Stage H Aqueous misdirection, right eye No Stage EyeCodingForum.com 259

260 Glaucoma Made Easy! No Stage code, with laterality (sixth digit code required) 1. H40.0* Glaucoma suspect 2. H40.01* Open angle with borderline findings, low risk 3. H40.02* Open angle with borderline findings, high risk 4. H40.03* Anatomical narrow angle 5. H40.04* Steroid responder 6. H40.05* Ocular hypertension 7. H40.06* Primary angle closure without glaucoma damage EyeCodingForum.com 260

261 Glaucoma Made Easy! No Stage code, with laterality (a sixth digit code) (4 each) 8. H40.15* Residual stage of open angle glaucoma 9. H40.21* Acute angle closure glaucoma 10. H40.23* Intermittent angle closure glaucoma 11. H40.24* Residual stage of angle closure glaucoma 12. H40.81* Glaucoma with increased episcleral venous pressure 13. H40.82* Hypersecretion glaucoma 14. H40.83* Aqueous misdirection EyeCodingForum.com 261

262 Glaucoma Made Easy! Stage Codes, no laterality (five codes each) [Note Placeholder code] 1. H40.10X* Unspecified open angle glaucoma 2. H40.11X* Primary open angle glaucoma 3. H40.20X* Unspecified primary angle closure glaucoma EyeCodingForum.com 262

263 Glaucoma Made Easy! Stage Codes plus laterality (20 codes each!) 1. H40.12** Low tension glaucoma 2. H40.13** Pigmentary glaucoma 3. H4014** Capsular glaucoma with pseudoexfoliation of lens 4. H40.22** Chronic angle closure glaucoma EyeCodingForum.com 263

264 Glaucoma Made Easy! Stage Codes plus laterality in the fifth digit location, note placeholder code plus second code! (20 codes each!) 1. H40.3*X* Glaucoma secondary to eye trauma, right eye [note fifth digit is laterality] 2. H40.4*X* Glaucoma secondary to eye inflammation 3. H40.5*X* Glaucoma secondary to other eye disorders 4. H40.6*X* Glaucoma secondary to drugs EyeCodingForum.com 264

265 Glaucoma Made Easy! Nothing: no stage, no laterality, no placeholder. short codes. 1. H40.89 Other specified glaucoma 2. H40.9 Unspecified glaucoma 3. H42 Glaucoma in diseases classified elsewhere EyeCodingForum.com 265

266 Drance heme (disc hemorrhage) Drance hemes are a risk factor for glaucoma and are disc hemorrhages that lie within the peripapillary retinal nerve fiber layer. They occur often in patients with normal tension glaucoma Hemorrhage in optic nerve sheaths But more certified coders listed this condition as: Retinal Hemorrhage H35.6* is the ICD 10 crosswalk. A few listed : Vitreous degeneration (I don t think so) Yes, Virginia, there will be disagreement among experts, certified coders, and providers! EyeCodingForum.com 266

267 Drance heme? ICD 9 to ICD 10 Crosswalk Program. H35.60 below is Retinal hemorrhage, unspecified eye is not considered equivalent to H What does this mean? It means the zero is an unspecified eye code. Reverse Lookup 1=right 2=left 3=bilateral EyeCodingForum.com 267