ICD-10-CM Are You Prepared? Part IV Posterior Segment

Transcription

1 ICD-10-CM Are You Prepared? Part IV Posterior Segment Rebecca H. Wartman OD April 2014 With contributions from Doug Morrow OD & Harvey Richman OD

2 Overview This webinar will provide an introduction to ICD-10-CM coding changes and begin your preparation There will be more information coming in the next few months to further prepare you for the change to ICD- 10-CM

3 Are You Well Connected?? Notice: To hear the audio portion of this webinar- Connect through your computer with a headset or through your telephone If you cannot get connected, you may contact Erin Nichols AOA TPC staff member, for assistance: EMNichols@AOA.org

4 Disclaimers for Presentation 1.All information was current at time it was prepared 2.Drawn from national policies, with links included in the presentation for your use 3.Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations 4.Prepared and presented carefully to ensure the information is accurate, current and relevant 5.No conflicts of interest exist for the presenterfinancial or otherwise

5 Disclaimers for Presentation 6. Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services 7. AOA, AOA-TPC, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein

6 Recording and Handouts for this Course Recorded presentation and webinar course handouts will be available at: Click ICD-10 on the right hand column and it will take you to all the available resources for ICD-10 Other helpful resources will soon be available as well

7 Q&A and After the Webinar AT THE END OF THE PRESENTATION: Questions will be answered at the end of the presentation, as time permits To ask a question that pertains to this presentation: Click on the red arrow to maximize the webinar control panel and expand the Questions section. Type inquiries in the dialog box and press Send AFTER THE WEBINAR Please send questions to

8 AOA Third Party Center Coding Experts Rebecca H. Wartman, O.D Douglas C. Morrrow, O.D Harvey B. Richman, O.D

9 BIG NEWS BIG NEWS BIG NEWS Congress voted last week to postpone ICD-10-CM until October 1, 2015! October 1, 2014 NOTHING WILL BE DIFFERENT THAN IT IS NOW Continue to use ICD-9-CM until October 1, 2015 MORE TIME TO PREPARE! NOW IS NOT THE TIME TO STOP YOUR PREPARATIONS!

10 Outline for ICD-10-CM Webinars Are you prepared? 10 Part Series January 10, 2014 Introduction to ICD-10-CM Coding System February 14,2014 ICD-10-CM More Basics March 21, 2014 April 11,2014 May 23,2014 June 20,2014 July 11,2014 August 8, 2014 ICD-10-CM Coding: Lids to Lens ICD-10-CM Coding: Posterior Segment ICD-10-CM Coding: Glaucoma-Optic Pathways ICD-10-CM Coding: Refraction, Muscles, Disturbances ICD-10-CM Coding: Diabetes and other systemic disease ICD-10-CM Coding: Common Ocular Infection and Injury September 5,2014 ICD-10-CM Coding: Post-procedural Complications October 3,2014 ICD-10-CM Coding: Odds and Ends and Recap There will be more ICD-10-CM courses added in 2015 to further expand your knowledge base. All are or will be recorded and posted to the AOA Eyelearn site within 3-5 business days after the original presentation

11 Topics for Tonight Diseases of the Posterior Segment Brief Overview of Chapter 7 Chapter 7 General Inclusions and Exclusions- Details Chapter 7 Details H30-H36 Disorders of choroid and retina H43-H44 Disorders of vitreous body and globe Questions Resources Self Assessment Review Questions With specific coding examples sprinkled throughout presentation

12 Tabular List Chapter 7 Categories (Slightly different list than in very first webinar- Official USA Version for ICD-10-CM) H00-H05 Disorders of eyelid, lacrimal system, orbit H10-H11 Disorders of conjunctiva H15-H22 Disorders of sclera, cornea, iris, ciliary body H25-H28 Disorders of lens H30-H36 Disorders of choroid and retina H40-H42 Glaucoma H43-H44 Disorders of vitreous body and globe H46-H47 Disorders of optic nerve & visual pathways H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction H53-H54 Visual disturbances and blindness H55-H57 Other disorders of eye and adnexa H 59 Intraoperative and postprocedural complications and disorders

13 Chapter 7 Diseases of the eye and adnexa (H00-H59) Overall Notes and Exclusions Note: Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition Excludes2: Certain conditions originating in the perinatal period (P04-P96) Certain infectious and parasitic diseases (A00-B99) Complications of pregnancy, childbirth and the puerperium (O00-O9A) Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) Diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-) Endocrine, nutritional and metabolic diseases (E00-E88) Injury (trauma) of eye and orbit (S05.-) Injury, poisoning and certain other consequences of external causes (S00-T88) Neoplasms (C00-D49) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) Syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)

14 Definition Reminder Excludes1: Excludes 1 note is pure excludes note- meaning NOT CODED HERE! Code excluded should never be used at same time as code above Excludes1 note Excludes1 used when two conditions cannot occur together (Example: congenital versus acquired form of same condition) Excludes2 Excludes2 note means Not included here Excluded condition is not part of condition represented by code BUT patient may have both conditions at the same time Excludes2 used when it is acceptable to use both code and excluded code together, when applicable

15 Disorders of choroid and retina (H30-H36) H30 Chorioretinal inflammation H31 Other disorders of choroid H32 Chorioretinal disorders in diseases classified elsewhere H33 Retinal detachments and breaks H34 Retinal vascular occlusions H35 Other retinal disorders H 36 Retinal disorders in diseases classified elsewhere

16 Alphabetical Index: Choriodal Conditions Chorioretinitis see also Inflammation, chorioretinal - disseminated see also Inflammation, chorioretinal, disseminated - focal see also Inflammation, chorioretinal, focal - histoplasmic B39.9 [H32] - in (due to) - - histoplasmosis B39.9 [H32] - - syphilis (secondary) A late A toxoplasmosis (acquired) B congenital (active) P37.1 [H32] Chorioretinopathy, central serous H Choroid see condition Choroideremia H31.21 Choroiditis see Chorioretinitis Choroidopathy see Disorder, choroid Choroidoretinitis see Chorioretinitis Syndromes, disorders etc tend to be listed this way in Alphabetical Index Choroidoretinopathy, central serous see Chorioretinopathy, central serous

17 Disorders of choroid H30 Excludes Notes Remember: Exclude2 note means these two CAN be coded together IF both conditions exist- one condition does not include the other condition

18 Disorders of choroid H31

19 Disorders of choroid H31

20 Disorders of choroid and retina H32 Entire Section Code First: You must code the other disease before you code the chorioretinal disorder Excludes1 code means you cannot code these diagnoses together

21 Chorioretinal Scar of Posterior Pole Example Alphabetic Index Scar, scarring (see also Cicatrix) L chorioretinal H posterior pole macula H postsurgical H solar retinopathy H specified type NEC H choroid see Scar, chorioretinal Go to H or H section of tabular listing Depends on the cause of the scar

22 Chorioretinal Scar, Posterior Pole OD Example Tabular Index Appropriate code might be H if macular But could be H if known solar retinopathy scar

23 Toxoplasmosis Scarring of Choroid OS Example Alphabetic Index Chorioretinitis see also Inflammation, chorioretinal - disseminated see also Inflammation, chorioretinal, disseminated - focal see also Inflammation, chorioretinal, focal - histoplasmic B39.9 [H32] - in (due to) - - histoplasmosis B39.9 [H32] - - syphilis (secondary) A late A toxoplasmosis (acquired) B congenital (active) P37.1 [H32] Toxoplasma, toxoplasmosis (acquired) B with - - hepatitis B meningoencephalitis B ocular involvement B other organ involvement B pneumonia, pneumonitis B congenital (acute) (subacute) (chronic) P maternal, manifest toxoplasmosis in infant (acute) (subacute) (chronic) P37.1 This would be the section to review for toxoplasmosis ocular involvement-both reference

24 Toxoplasmosis Scarring of Choroid OS Tabular Lookup The code for toxoplasmosis scar of choroid would be found here and not under the H 30 or H31 sections REMEMBER the Excludes1 note we reviewed Code would be B58.01 NOT PER EYE

25 Choroidal Nevus, Both eyes Example Alphabetical Index Nevus D achromic see Neoplasm, skin, benign - amelanotic see Neoplasm, skin, benign... - choroid D comedonicus Q conjunctiva D31.0- Note: neither choroidal or conjunctival Nevus is under H coding

26 Choroidal Nevus, Both eyes Example Tabular Listing Note that this code is per eye while some in sections other than H Chapter VII are not NEED TO USE BOTH D31.31 AND D31.32

27 Alphabetic Index: Disorders of the Retina H33 Retina, retinal see also condition - dark area D49.81 Detachment - retina (without retinal break) (serous) H with retinal: break H giant H multiple H single H dialysis H pigment epithelium see Degeneration, retina, separation of layers, pigment epithelium detachment - - rhegmatogenous see Detachment, retina, with retinal, break - - specified NEC H total H traction H vitreous (body) H43.81 NOTE: Only one entry under Retina so must look under specific condition

28 Alphabetic Index: Disorders of the Retina H33 Retinochoroiditis see also Inflammation, chorioretinal - disseminated see Inflammation, chorioretinal, disseminated - - syphilitic A focal see Inflammation, chorioretinal - juxtapapillaris see Inflammation, chorioretinal, focal, juxtapapillary Retinopathy (background) H arteriosclerotic I70.8 [H35.0-] - atherosclerotic I70.8 [H35.0-] - central serous see Chorioretinopathy, central serous - Coats H diabetic see Diabetes, retinopathy - exudative H hypertensive H Retinoschisis H congenital Q specified type NEC H Carefully note the sections and the codes in [ ] For Alphabetic Index Both conditions are listed together Etiology code first then manifestation codes [ ] Code in brackets always coded second

29 Alphabetic Index: Disorders of the Retina H33 Retinitis see also Inflammation, chorioretinal - albuminurica N18.9 [H32] - diabetic see Diabetes, retinitis - disciformis see Degeneration, macula - focal see Inflammation, chorioretinal, focal - gravidarum see Pregnancy, complicated by, specified pregnancy-related condition NEC - juxtapapillaris see Inflammation, chorioretinal, focal, juxtapapillary - luetic see Retinitis, syphilitic - pigmentosa H proliferans see Disorder, globe, degenerative, specified type NEC - proliferating see Disorder, globe, degenerative, specified type NEC - renal N18.9 [H32] - syphilitic (early) (secondary) A central, recurrent A congenital (early) A50.01 [H32] - - late A tuberculous A18.53 Only a few of these codes are found under Section H

30 Disorders of the Retina H33 Exclusion Notes

31 Disorders of retina (H34-H35.38) Excludes Notes to Understand for Retina NOTE: Diabetic Retinopathy is NOT coded under retina

32 Disorders of retina (H35.4-H36) Excludes Notes to Understand for Retina

33 Retinal Detachment Giant Tear-Right Eye Example Alphabetical Index Detachment - retina (without retinal break) (serous) H with retinal: break H giant H This would be where to start REMEMBER: few listings under retina must look under conditiondetachment

34 Retinal Detachment Giant Tear-Right Eye Example Tabular Look Up First understand entire section THEN go to the code Final Code would be H33.031

35 Lattice Degeneration of Retina Both Eyes Example Alphabetic Look Up Degeneration, degenerative - retina H hereditary (cerebroretinal) (congenital) (juvenile) (macula) (peripheral) (pigmentary) see Dystrophy, retina - - Kuhnt-Junius (see also Degeneration, macula) H macula (cystic) (exudative) (hole) (nonexudative) (pseudohole) (senile) (toxic) see Degeneration, macula - - peripheral H lattice H microcystoid H paving stone H secondary pigmentary H vitreoretinal H senile reticular H Find the condition not under retina, not under Lattice, but under degeneration

36 Lattice Degeneration of Retina Both Eyes Example Tabular Look Up Find the final after READING all exclusions for section Final code would be H35.413

37 Moderate Dry ARMD Both Eyes Example Alphabetic Index Macula - cornea, corneal see Opacity, cornea - degeneration (atrophic) (exudative) (senile) see also Degeneration, macula - - hereditary see Dystrophy, retina Degeneration, degenerative - macula, macular (acquired) (age-related) (senile) H angioid streaks H atrophic age-related H congenital or hereditary see Dystrophy, retina - - cystoid H drusen H exudative H hole H nonexudative H puckering H toxic H Find description that best fits the clinical picture Again not under Macula Could be H35.30 H35.31 or H35.36-

38 Moderate Dry ARMD Both Eyes Example Tabular Look Up Be careful here since it is NOT eye specific nor degree specific- just when you THOUGHT you had it figured out! If only drusen you would code H35.363

39 Disorders of choroid and retina (H43.0 H44.9) Excludes Notes to Understand for Vitreous/Orbit

40 Disorders of choroid and retina (H43.0 H44.9) Excludes Notes to Understand for Vitreous/Orbit

41 Posterior Vitreal Detachment Left Eye Example Alphabetic Index Vitreal corneal syndrome H Vitreoretinopathy, proliferative see also Retinopathy, proliferative - with retinal detachment see Detachment, retina, traction Vitreous see also condition - touch syndrome see Complication, postprocedural, following cataract surgery Detachment - vitreous (body) H43.81 Vitreous does not list but found under detachment

42 Posterior Vitreal Detachment Left Eye Example Tabular Look Up Note: two different descriptions: degeneration and detachment Code you would use! Final code= H43.812

43 Resources CDC ICD-10-CM Official USA site release of ICD-10-CM at bottom of page has all the downloads ICD-10-CM Guidelines [PDF KB] ICD-10-CM PDF Format ICD-10-CM List of codes and Descriptions (updated 7/3/2013) CMS ICD-10-CM information American Optometric Association

44 Finally Questions?

45 Review Questions Answers will be posted on ICD-10-CM AOA Page 1. Disseminated choroidal inflammation (H 30.1) can or cannot be coded at the same time as Exudative retinopathy (H )? a) Could be coded at the same time b) Could not coded at the same time 2. Another term for Posterior Cyclitis is: a) Angioid Streaks b) Retinochorioditis c) Pars planitis d) Focal Choroiditis

46 Review Questions Answers will be posted on ICD-10-CM AOA Page 3. Congenital retinoschisis of both eyes is coded with: a) H b) H and Q14.1 c) Q and H d) Q Arteriosclerotic retinopathy of the right eye would be coded with: a) H b) H c) H and I 10, in this order d) I 70.8 and H35.011, in this order

47 Review Questions Answers will be posted on ICD-10-CM AOA Page 5. Posterior vitreal detachment is coded using: a) H b) H c) H d) H Endophthalmitis due to a bleb in the left eye is coded with: a) H b) H59.41 c) H59.43 d) H44.199

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