WELCOME TO PMI s WEBINAR PRESENTATION Brought to you by: MEET THE PRESENTER Jeffrey Restuccio On the topic: ICD-10 Update for Ophthalmology & Optometry
Welcome to s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year, more than 40,000 physicians and office staff are trained by. For 30 years, physicians have relied on PMI to provide up-to-date coding, reimbursement, compliance and office management training. Instructor-led classes are presented in 400 of the nation s leading hospitals, healthcare systems, colleges and medical societies. PMI provides a number of other training resources for your practice, including national conferences for medical office professionals, self-paced certification preparatory courses, online training, educational audio downloads, and practice reference materials. For more information, visit PMI s web site at Please be advised that all information in this program is provided for informational purposes only. While PMI makes all reasonable efforts to verify the credentials of instructors and the information provided, it is not intended to serve as legal advice. The opinions expressed are those of the individual presenter and do not necessarily reflect the viewpoint of Practice Management Institute. The information provided is general in nature. Depending on the particular facts at issue, it may or may not apply to your situation. Participants requiring specific guidance should contact their legal counsel. CPT is a registered trademark of the American Medical Association. 8242 Vicar San Antonio, Texas 78218-1566 tel: 1-800-259-5562 fax: (210) 691-8972 info@pmimd.com
ICD-10 Update for Ophthalmology & Optometry Jeffrey Restuccio, CPC, CPC-H, MBA Coding and Billing Consultant specializing in Eyecare Memphis TN (901) 517-1705 jeff@eyecodingforum.com www. 1 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 1 2015. ICD-10 has 68,000 codes compared to only 13,000 ICD-9 codes. 2
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. 3 HIPAA Non-Covered Entities Can I use ICD-9 codes after October 1, 2015? All HIPAA* 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, 2015. Non-Covered Entities include: 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 2015. Be sure to contact your state agency. * Health Insurance Portability and Accountability Act. 4
Why are we upgrading to ICD-10? Remember, the data you send does not stop at the insurance carrier. It is further analyzed by the World Health Organization (WHO), the Center for Disease Control (CDC) and used worldwide for research to improve healthcare: 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. 5 Top Ten Misconceptions concerning ICD-10 1. ICD-10 training will cost you lots of money. 2. All medical practices need to get a line of credit. 3. ICD-10 is primarily an administrative function. 4. I don t have time to write a book! 5. ICD-10 is a conspiracy by the insurance companies to not pay me. 6
Top Ten Misconceptions concerning ICD-10 6. My practice management software vendor told me they would handle everything. 7. There are hundreds of new, specific disease codes in ICD-10. 8. I ll wait until a month before the implementation date of Oct. 1 2015. 9. ICD-10 is going to reduce my revenue. 10. The insurance companies don t need all this detail. 7 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. 8
What is SNOMED? SNOMED Clinical Terms (SNOMED CT) is a comprehensive, computerized healthcare terminology containing more than 311,000 active concepts with the purpose of providing a common language across different providers and sites of care. As a core EHR terminology, SNOMED CT is essential for recording clinical data such as patient problem lists and family, medical and social histories in electronic health records in a consistent, reproducible manner. SNOMED CT can be mapped to other coding systems, such as ICD-9 and ICD-10, which helps facilitate semantic interoperability. 9 Ritecode.com SNOMED VS ICD-10 ICD-10 is a classification system, and SNOMED CT is a clinical terminology system; each were designed to serve different purposes. SNOMED CT can be utilized at the point of care as input, while the ICD classification is viewed as output for specific data uses, including reimbursement and statistical indexing. The major difference is that ICD is a classification which is limited to disease, Bowman explains. SNOMED CT provides a common language for systems to adopt for indexing, storing, retrieving, and aggregating clinical data across every specialty and health-care related setting. The classification is useful for categorizing diseases and recording diagnostic and procedural information. 10 Ritecode.com
ICD-10 Code Format [ ] [ ] [ ]. [ ] [ ] [ ] [ ] Category (letter), etiology, anatomic site, severity and then a seventh-digit "extender" B20 Human immunodeficiency virus [HIV] disease D31.32 Benign neoplasm of left choroid E11.9 Type 2 diabetes mellitus without complications H00.11 Chalazion right upper eyelid H40.11X1 Primary open-angle glaucoma, mild stage H52.11 Myopia, right eye H52.4 Presbyopia G43.009 Migraine w/o aura, not intractable, w/o status migrainosus T15.02XA Foreign body in cornea, left eye, initial encounter Z96.1 Presence of intraocular lens 11 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. 12
Won t my Billing System do all of this for me? 13 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 to code and report the new codes? The simple answer is No. If the documentation is not there, you cannot report it. 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. The goal of ICD-10 is to improve the accuracy and specificity of all coding and reporting across the board. The expectations will be higher. Won t my Billing System do all of this for me? Other specific reasons include: Some codes do not have a crosswalk. Some common terms such as viral/bacterial conjunctivitis, temporal/nasal pterygium, and dense cataract do not have ICD-10 codes. Acronyms such as PVD and DES are not in ICD-10. Enhanced descriptions and explanations Lack of coding guideline information such as the Includes and Excludes 1 and 2 instructions plus coding additional codes. 14
15 What about instructions 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 and always report 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. Examples of additional codes Code a Z16.* resistance code for any condition that is pharmacoresistant to treatment. Code Z79.4: Long-Term Use of insulin for all diabetes type II patients. Always document and report the toxic agent for: toxic conjunctivitis [H10.21*], maculopathy [H35.38*], and optic neuropathy [H46.3]. Code also instructions for secondary glaucoma and diseases classified elsewhere. All of these instructions are in ICD-9 today but many do not document or report them. 16
Work on ICD-9 Guidelines today! 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.] 17 Action Plan to Prepare for ICD-10 1. 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 1 2015. Remember, the number of codes expand over 4X. The issue is that the codes won t fit on one to two pages. 18
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. 19 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. 20
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. 21 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. Diabetes Mellitus Keratoconus Keratitis ARMD Entropion Ectropion Lagophthalmos Astigmatism Cataracts Epiphora Conjunctivitis Adverse effects Reason and location of accidents Headaches 22
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. 23 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). 24
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*) 25 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. 26
What is GEMS? The General Equivalence Mappings (GEMS) http://www.ahacentraloffice.org/ahacentraloffice/shtml/icdgem.shtml 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. 27 GEMS resources CMS has a webpage and all the resources are available for free. But accessing them and using the files takes some work. http://www.cms.gov/medicare/coding/icd10/2013-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. 28
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. 29 Simple GEMS conversion (ICD-9) Rank ICD-9 Description 1Top 36721 27 code Regular list Astigmatism from a typical clinic. 2 3671 Myopia 3 3674 Presbyopia 4 3670 Hypermetropia 5 36616 Senile nuclear sclerosis 6 36504 Ocular hypertension 7 36615 Cortical senile cataract 8 36511 Primary open angle glaucoma 9 37300 Blepharitis unspecified 10 2245 Benign neoplasm of retina 11 37200 Acute conjunctivitis unspecified 12 37272 Conjunctival hemorrhage 13 37311 Hordeolum externum 30
31 Simple GEMS conversion Ran k Top ICD-9 27 code list from a typical Description clinic. T 14 25000 Diabetes mellitus without complication type II or unspecified type not stated as uncontrolled 15 36614 Posterior subcapsular polar senile cataract 16 37515 Tear film insufficiency unspecified 17 36250 Macular degeneration (senile) of retina unspecified 18 36257 Drusen (degenerative) of retina 19 36500 Preglaucoma unspecified 20 36502 Anatomical narrow angle borderline glaucoma 21 36510 Open-angle glaucoma unspecified 22 37210 Chronic conjunctivitis unspecified The example on the next two slides is a simple GEMS mapping. Only the stage codes are expanded. 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 32
33 GEMS ICD-10 Crosswalk (2 of 2) ICD10 Common description H1033 Conjunct, unsp acute bilat H1133 Conjunctival hemorrhage, bilat H00019 Hordeolum ext unsp eye, unsp eyelid E119 DM T2 w/o complications H25049 Cat, Post subc polar a/r unsp eye H04129 Dry eye syndr of unsp lacr gl H3530 Macular degen,unsp H35369 Drusen (degen) of macula, unsp eye H40009 Preglaucoma, unsp, unsp eye H40039 Glauc, Anat narrow/ angle, unsp eye H4010X3 Glauc, unsp O-A, sev st H4010X0 Glauc, unsp O-A, stage unsp H4010X2 Glauc, unsp O-A, mod st H4010X4 Glauc, unsp O-A, ind st H4010X1 Glauc, unsp O-A, mild stage H10409 Conjunct, unsp chron unsp eye 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.] 34
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 35 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 36
Lacrimal Gland Codes Lacrimal Gland Codes (1,2,3, 9) map to RT, LT, bilateral and unspecified. H04.011 Acute dacryoadenitis, right lacrimal gland H04.012 Acute dacryoadenitis, left lacrimal gland H04.013 Acute dacryoadenitis, bilateral lacrimal glands H04.019 Acute dacryoadenitis, unspecified lacrimal gland 37 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 38
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. 39 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 encounter T15.01XD encounter T15.01XS Foreign body in cornea, right eye, initial Foreign body in cornea, right eye, subsequent Foreign body in cornea, right eye, sequela Note: all above are for the right eye; fifth digit = 1. 40
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 is 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 41 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. 42
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. 43 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. 44
H52.***: Refraction Disorders These are not medical diagnoses. They should primarily be used with CPT code 92015. 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 92015 and refraction diagnosis codes. However some medical insurance carriers pay on medical diagnosis codes linked to 92015. 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. 45 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. 46
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 47 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. 48
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] 49 H52.2 **: Astigmatism Regular astigmatism: principal meridians are perpendicular. Irregular astigmatism: principal meridians are not perpendicular. H52.201 Unspecified astigmatism, right eye [Laterality] H52.211 Irregular astigmatism, right eye [Laterality] H52.221 Regular astigmatism, right eye [Laterality] 50
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. 51 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 H49.40 Progressive external ophthalmoplegia, unspecified eye H49.41 Progressive external ophthalmoplegia, right eye H49.42 Progressive external ophthalmoplegia, left eye H49.43 Progressive external ophthalmoplegia, bilateral 52
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. H52.511 Internal ophthalmoplegia (complete) (total), right eye H52.521 Paresis of accommodation, right eye H52.531 Spasm of accommodation, right eye 53 H10.***: Conjunctival conditions H10.011 Acute follicular conjunctivitis, right eye H10.021 Other mucopurulent conjunctivitis, right eye H10.11 Acute atopic conjunctivitis, right eye H10.211 Acute toxic conjunctivitis, right eye H10.221 Pseudomembranous conjunctivitis, right eye H10.231 Serous conjunctivitis, except viral, right eye H10.31 Unspecified acute conjunctivitis, right eye H10.401 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. And, where is viral conjunctivitis? 54
Viral Conjunctivitis B00.52 Herpesviral keratitis B00.53 Herpesviral conjunctivitis B30.0 Keratoconjunctivitis due to adenovirus B30.1 Conjunctivitis due to adenovirus B30.2 Viral pharyngoconjunctivitis B30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral) B30.8 Other viral conjunctivitis B30.9 Viral conjunctivitis, unspecified 55 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. H11.001 Unspecified pterygium of right eye H11.011 Amyloid pterygium of right eye H11.021 Central pterygium of right eye H11.031 Double pterygium of right eye H11.041 Peripheral pterygium, stationary, right eye H11.051 Peripheral pterygium, progressive, right eye H11.061 Recurrent pterygium of right eye 56
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. H25.011 Cortical age-related cataract, right eye H25.031 Anterior subcapsular polar age-related cataract, right eye H25.041 Posterior subcapsular polar age-related cataract, right eye H25.091 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 366.18) H25.811 Combined forms of age-related cataract, right eye [common] 57 ICD-10 Glaucoma stage codes Sixth digit is right eye or 1. Seventh digit stage options are 0, 1, 2, 3 and 4. H40.1410 Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified H40.1411 Same as above == > mild stage H40.1412 Same as above == > moderate stage H40.1413 Same as above == > severe stage H40.1414 Same as above == > indeterminate stage 58
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 59 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 60
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 61 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 62
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 63 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 64
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. 377.42 Hemorrhage in optic nerve sheaths But more certified coders listed this condition as: 362.81 Retinal Hemorrhage H35.6* is the ICD-10 crosswalk. A few listed 379.21: Vitreous degeneration (I don t think so) Yes, Virginia, there will be disagreement among experts, certified coders, and providers! 65 66 H44.***: Disorders of vitreous body and globe Multifocal choroiditis/panuveitis (MCP) is an idiopathic inflammatory disorder of unknown etiology affecting the choroid, retina, and vitreous of the eye. H44.001 Unspecified purulent endophthalmitis, right eye H44.011 Panophthalmitis (acute), right eye H44.021 Vitreous abscess (chronic), right eye H44.111 Panuveitis, right eye [all parts of the uvea] H44.121 Parasitic endophthalmitis, unspecified, right eye H44.131 Sympathetic uveitis, right eye H44.21 Degenerative myopia, right eye The uvea is exactly where in the eye? This was discussed in the anatomy module.
Degenerative myopia H44.21: Degenerative myopia is a medical Dx. This presents for the majority of people, as an inherited genetic condition where the eye exhibits an accelerated growth rate and becomes much longer than normal. The eye is said to have high axial myopia (nearsightedness). 67 H55.***: Nystagmus Nystagmus a condition of involuntary eye movement. H55.00 Unspecified nystagmus H55.01 Congenital nystagmus H55.02 Latent nystagmus H55.03 Visual deprivation nystagmus H55.04 Dissociated nystagmus H55.09 Other forms of nystagmus H55.81 Saccadic eye movements [fast movement of an eye] H55.89 Other irregular eye movements 68
Migraine headaches (without aura) G43001 G43009 G43011 G43019 Migraine without aura, not intractable, with status migrainosus Migraine without aura, not intractable, without status migrainosus Migraine without aura, intractable, with status migrainosus Migraine without aura, intractable, without status migrainosus 69 Migraine headache (with aura) G43101 G43109 G43111 G43119 Migraine with aura, not intractable, with status migrainosus Migraine with aura, not intractable, without status migrainosus Migraine with aura, intractable, with status migrainosus Migraine with aura, intractable, without status migrainosus 70
Ocular Migraine [G43.B0] The term "ocular migraine" can be confusing as some use the term to refer to a retinal migraine; one of which usually isn't cause for concern, and the other which might have more serious complications. In some cases, ocular migraine describes a migraine aura that involves your vision. Migraine auras include a variety of sensations often visual, but which also may include other sensations, such as numbness that precede or accompany a migraine. Aura can sometimes occur without an associated headache. A migraine aura that affects your vision is common. Visual symptoms are short lasting. A migraine aura involving your vision will affect both eyes, and the patient will see: Flashes of light Zigzagging patterns Blind spots Shimmering spots or stars 71 Migraine Aura Without Headache The condition has many names: optical migraine: ocular migraine, acephalgic migraine, acephalalgic migraine, migraine aura without headache, and amigrainous migraine. The patient may experience visual aura, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache. B43.B0 ophthalmoplegic without refractory migraine (not intractable) 72
Retinal Migraine [G43.81] Retinal migraine: involves repeated bouts of short lasting, diminished vision or blindness. These bouts may precede or accompany a headache. A retinal migraine unlike a migraine aura affecting vision will affect only one eye, not both. However, most often, loss of vision in one eye isn't related to migraine. It's generally caused by some other more serious condition. 73 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. 918.1 Corneal abrasion S05.01XA An Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter 930.0 Corneal FB T15.0*X* [see next slide] 74
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 75 Burn Codes (T26.**) Foreign body codes, T15.**X* were covered in the Introduction. T26.**X*: Burns of the eye and internal organs (T26-T28) are classified by site, but not by degree. T26.01X* T26.11X* T26.21X* T26.31X* T26.41X* Burn of right eyelid and periocular area Burn of cornea and conjunctival sac, right eye Burn with resulting rupture and destruction of right eyeball Burns of other specified parts of right eye and adnexa Burn of right eye and adnexa, part unspecified 76
S00.201A S00.211A ICD-10 Injury and Abrasion Codes All are listed with right eyelid and Initial Encounter. No superficial cornea or conjunctiva injury ICD-10 codes. S00.221A S00.241A S00.251A Unspecified superficial injury of right eyelid and periocular area, initial encounter [12 codes] Abrasion of right eyelid and periocular area, initial encounter [12 codes] Blister (nonthermal) of right eyelid and periocular area, initial encounter [12 codes] External constriction of right eyelid and periocular area, initial encounter [12 codes] Superficial foreign body of right eyelid and periocular area, initial encounter [ 12 codes] 77 W Codes These codes indicate the activity that caused the injury. W27.0 Contact with workbench tool W31.1 Contact with metalworking machines W31.2 Contact with powered woodworking and forming machines W39 Discharge of firework 78
Y Location Codes While there are many more location codes, perhaps the five below would be a good first start. Y92.009 Unspecified place in unspecified non-institutional (private) residence [home] Y92.099 Unspecified place in other non-institutional residence as the place of occurrence of the external cause Y92.219 Unspecified school as the place of occurrence of the external cause Y92.63 Factory as the place of occurrence of the external cause Y92.830 Public park as the place of occurrence of the external cause 79 Z codes: Factors influencing health status and contact with health service These were V codes in ICD-9. Z18.10 Retained metal fragments, unspecified Z18.11 Retained magnetic metal fragments Z18.12 Retained nonmagnetic metal fragments Z18.2 Retained plastic fragments Z18.33 Retained wood fragments Z18.39 Other retained organic fragments Z18.81 Retained glass fragments Z18.83 Retained stone or crystalline fragments Z18.89 Other specified retained foreign body fragments Z18.9 Retained foreign body fragments, unspecified material 80
81 Family History Codes (Z83.**) Z65.2 Malingerer [person feigning illness [V65.2] Z82.1 Family history of blindness and visual loss Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system Z83.3 Family history of diabetes mellitus Z83.49 Family history of other endocrine, nutritional and metabolic diseases Z83.511 Family history of glaucoma Z83.518 Family history of other specified eye disorder Z91.19 Patient's noncompliance with other medical treatment and regimen [V15.81] Z94.7 Corneal transplant status 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. 82
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. Visual aura 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. 83 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 specific 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. 84
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 Z83.511 Family history of glaucoma Z83.518 Family history of other specified eye disorder Z94.7 Corneal transplant status Z85.840 Personal history of malignant neoplasm of eye Personal history of (corrected) congenital malformations of Z87.720 eye 85 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. 86
Glaucoma Glaucoma Suspect: Laterality Only. No stage. All four codes are listed. This is a six-digit code. H40.001 Preglaucoma, unspecified, right eye H40.002 Preglaucoma, unspecified, left eye H40.003 Preglaucoma, unspecified, bilateral H40.009 Preglaucoma, unspecified, unspecified eye 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-10 365.70 glaucoma stage, unspec 0 365.71 glaucoma stage, mild 1 365.72 glaucoma stage, moderate 2 365.73 glaucoma stage, severe 3 365.74 glaucoma stage, indeterminate stage 4 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 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. H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage ICD-9: 365.52 Pseudoexfoliation glaucoma and ICD-9: 365.73 Severe stage glaucoma [two codes] 90 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
91 Pseudoexfoliation glaucoma (20 codes) 1 H40.1410 Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified 2 H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage 3 H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage 4 H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage 5 H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage 6 H40.1420 Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified 7 H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage 8 H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage 9 H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage 10 H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage 11 H40.1430 Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified 12 H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage 13 H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage 14 H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage 15 H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage 16 H40.1490 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, stage unspecified 17 H40.1491 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage 18 H40.1492 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, moderate stage 19 H40.1493 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, severe stage 20 H40.1494 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate Macula and ARMD ICD-9 Description ICD-10 code and description 362.51 ARMD dry H35.31 ARMD dry [No Laterality] 362.52 ARMD wet H35.32 ARMD wet [No Laterality] 362.57 Drusen H35.361 Drusen (degenerative) of macula, right eye [Laterality] 377.21 Drusen, optic disc H47.321 Drusen of the optic disc, right eye. [Laterality] 92
Diabetes Is Not Coded By Eye E10.*** E11.*** Type 1 DM 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. 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 250.00 DM II, controlled => complications E10.9 Type 1 diabetes mellitus without 250.01 DM I, controlled => complications E11.65 Type 2 diabetes mellitus with 250.02 DM II, uncontrolled => hyperglycemia E10.65 Type 1 diabetes mellitus with 250.03 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. 94
Diabetes ICD-9 Fourth digit = 5, with Ophthalmic manifestation Ophthalmic Manifestation 250.50 DM II, controlled 250.51 DM I, controlled 250.52 DM II, uncontrolled 250.53 DM I, uncontrolled 95 Diabetic Retinopathy In ICD-9, two codes must be reported for diabetic retinopathies. Mild, moderate, and severe are all considered background retinopathy. 362.02 Diabetic retinopathy: proliferative diabetic retinopathy 362.03 Diabetic retinopathy: nonproliferative diabetic retinopathy NOS 362.04 Diabetic retinopathy: mild nonproliferative diabetic retinopathy 362.05 Diabetic retinopathy: moderate nonproliferative diabetic retinopathy 362.06 Diabetic retinopathy: severe nonproliferative diabetic retinopathy 362.07 Diabetic retinopathy: diabetic macular edema In ICD-10 there are no longer two codes for diabetic retinopathies. 96
ICD-10 DM Type 1 w/ Eye Manifestation (1 of 2) Type 1 diabetes mellitus with unspecified diabetic retinopathy with E10.311 macular edema Type 1 diabetes mellitus with unspecified diabetic retinopathy E10.319 without macular edema Type 1 diabetes mellitus with mild nonproliferative diabetic E10.321 retinopathy with macular edema Type 1 diabetes mellitus with mild nonproliferative diabetic E10.329 retinopathy without macular edema Type 1 diabetes mellitus with moderate nonproliferative E10.331 diabetic retinopathy with macular edema Type 1 diabetes mellitus with moderate nonproliferative diabetic E10.339 retinopathy without macular edema 97 ICD-10 DM Type 1 w/ Eye Manifestation (2 of 2) Type 1 diabetes mellitus with severe nonproliferative diabetic E10.341 retinopathy with macular edema Type 1 diabetes mellitus with severe nonproliferative diabetic E10.349 retinopathy without macular edema Type 1 diabetes mellitus with proliferative diabetic E10.351 retinopathy with macular edema Type 1 diabetes mellitus with proliferative diabetic retinopathy E10.359 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.*** 98
99 List with short descriptions (12 codes) ICD-10 Short Description E10311 DMT1 w/ prl db ret w mac edem E10319 DMT1 w/ unsp DM ret w/o mac edem E10321 DMT1 w/ mld non-prl db ret w/mac edem E10329 DMT1 w/ mld non-prl db ret w/o mac edem E10331 DMT1 w/ mod DM ret w/ mac edem E10339 DMT1 w/mod non-prl db ret w/omac edem E10341 DMT1 w/sev non-prl db ret w/ mac edem E10349 DMT1 w/sev non-prl db ret w/o mac edem E10351 DMT1 w/ prol db ret w mac edem E10359 DMT1 w/ prol db ret w/o mac edem E1036 DMT1 w/ db cataract E1039 DMT1 w/ db cataract w/ oth ophth compl 100 Cataracts Age-Related 366.12 Senile cataract: incipient cataract 366.13 Senile cataract: ant. subcapsular polar senile cataract 366.14 Senile cataract: post subcapsular polar senile cataract 366.15 Senile cataract: cortical senile cataract 366.16 Senile cataract: nuclear sclerosis H25.091 Other age-related incipient cataract, right eye H25.031 Anterior subcapsular polar agerelated cataract, right eye. H25.041 Posterior subcapsular polar agerelated cataract, right eye H25.011 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.
Cataracts Juvenile Numerous types depending on age and location. These codes are not coded specifically in ICD-9 Ant Subs 366.01 Cataract: infantile, juvenile, and presenile cataract: anterior subcapsular polar cataract Post subs 366.02 : posterior subcapsular polar cataract H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye Cortical 366.03 : cortical, lamellar, or zonular cataract H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye Nuclear 366.04 : nuclear cataract H26.031 Infantile and juvenile nuclear cataract, right eye 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. 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. 366.52 Cataract: aftercataract: not obscuring vision 366.53 Cataract: aftercataract: obscuring vision H26.491 Other secondary cataract, right eye [one code] H26.491 Other secondary cataract, right eye [same code as above] 103 Congenital Codes Examples of a unspecific ICD-10 crosswalk. 743.32 Congenital cataract and lens anomalies: cortical and zonular cataract 743.33 Congenital cataract and lens anomalies: nuclear cataract 743.30 Congenital cataract and lens anomalies: congenital cataract, unspecified Q12.0 Congenital cataract Q12.0 Congenital cataract Q12.0 Congenital cataract 104
Inflammation Codes There are nine options below for scleritis. Same sub-terms in ICD- 9. 379.00 scleritis, unspecified 379.01 episcleritis periodica fugax H15.111 Episcleritis periodica fugax, right eye 379.02 nodular episcleritis H15.121 Nodular episcleritis, right eye 379.03 anterior scleritis H15.011 Anterior scleritis, right eye 379.04 scleromalacia perforans H15.051 Scleromalacia perforans, right eye 379.05 scleritis with corneal H15.041 Scleritis with corneal involvement, right involvement eye 379.06 brawny scleritis H15.021 Brawny scleritis, right eye 379.07 posterior scleritis H15.031 Posterior scleritis, right eye 379.09 Scleritis and episcleritis: other H15.091 Other scleritis, right eye 105 Aphakia Crosswalk to ICD-10 379.31 Aphakia and other disorders of lens: aphakia 379.32 Aphakia and other disorders of lens: subluxation of lens 379.33 Aphakia and other disorders of lens: anterior dislocation of lens 379.34 Aphakia and other disorders of lens: posterior dislocation of lens 379.39 Aphakia and other disorders of lens: other disorders of lens 743.35 Congenital cataract and lens anomalies: congenital aphakia 743.36 Congenital cataract and lens anomalies: anomalies of lens shape H27.01 aphakia, right eye H27.111 Subluxation of lens, right eye H27.121 Anterior dislocation of lens, right eye H27.131 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 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! 374.00 Entropion and trichiasis of eyelid: unspecified H02.001 Unspecified entropion of right upper eyelid 374.01 : senile entropion H02.031 Senile entropion of right upper eyelid 374.02 : mechanical entropion H02.021 Mechanical entropion of right upper eyelid 374.03 : spastic entropion H02.041 Spastic entropion of right upper eyelid 374.04 : cicatricial entropion H02.011 Cicatricial entropion of right upper eyelid 374.05 : trichiasis without entropion H02.051 Trichiasis without entropion right upper eyelid 107 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 108
Common Signs and Symptoms 368.00 amblyopia, unspecified H53.001 Unspecified amblyopia, right eye 368.2 diplopia H53.2 diplopia [no laterality] 379.91 eye pain H57.11 Ocular pain, right eye 368.15 Halo, photopsia H53.19 other subjective visual disturbances (halo) 368.10 subj visual disturbance H53.10 Unspecified subjective visual disturbances 368.11 sudden visual loss H53.131 Sudden visual loss, right eye 368.12 transient visual loss H53.121 Transient visual loss, right eye 368.13 Visual discomfort H53.141 Visual discomfort, right eye 368.14 Visual distortion of shape and size H53.15 Visual distortion of shape and size [no laterality] 435.9 TIA G45.9 TIA 109 Other visual signs/symptoms PVD is not listed in the ICD-9 or ICD-10 manual 379.24 Other vitreous opacities [Floaters] H43.391 Other vitreous opacities, right eye [Crosswalk, floaters] 361.32 retinal tear H33.311 Horseshoe tear of retina without detachment, right eye 379.21 Disorders of vitreous body: vitreous degeneration [PVD] H43.811 Vitreous degeneration, right eye [Posterior Vitreous Detachment (PVD)] 361.31 Retinal defects w/o detachment: round hole of retina w/o detachment H33.321 Round hole, right eye 110
111 Miscellaneous Codes Dry Eye Syndrome is now listed in ICD-10 A choroidal nevus is a benign neoplasm 373.01 Blepharitis H01.011 Ulcerative blepharitis right upper eyelid 372.13 conjunctivitis H10.44 Vernal conjunctivitis 375.15 tear film insufficiency, H04.121 Dry eye syndrome of right lacrimal gland 360.31 hypotony [Reduced tension H44.441 Primary hypotony of right eye or pressure] 346.00 migraine headache G43.109 Migr w/ aura, not intr, w/o S.M. 377.01 papilledema H47.11 papilledema 224.6 choroidal nevus D31.31 Benign neoplasm of right choroid ICD-9 Screening Codes for Plaquenil Report code V58.69 for a screening of current long-term use of a high-risk drug. Report V67.51 for an exam following completed treatment with high-risk medication NEC [Plaquenil]. Report 714.0 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: E931.4.This code is specifically for this substance. 112
ICD-10 Screening Codes Report Z79.899 for current long-term Plaquenil use for rheumatoid arthritis (LT use). Report Z09 for an exam following completed treatment with highrisk 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. 113 Adverse Effect [5]: Plaquenil T37.2X1* Poisoning by antimalarials and drugs acting on other blood protozoa, accidental (unintentional) T37.2X2* Poisoning by antimalarials and drugs acting on other blood protozoa, intentional selfharm T37.2X3* Poisoning by antimalarials and drugs acting on other blood protozoa, assault T37.2X4* T37.2X5* T37.2X6* 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 114 These are often called drug or poisoning codes. The Underdosing term and concept is new to ICD-10. * Represents the occurrence codes: A, D or S
Webinar/Audio Conference February 18, 2015 Punctal Plugs: ICD-9 NPI Number Use for unlisted codes, co-management and unique situations 365.02 375.15 anat. narrow angle glaucoma 333.81 blepharospasm DES 250.00 DM Type II, controlled Units 10/15/2012 11 99214 10/15/2012 11 68761 10/15/2012 11 68761 25 1, 2, 4 1 E1 3 1 51 E2 3 1 MOD-51 is added to second procedure on other eyelid. 115 Punctal Plugs: ICD-10 NPI Number H40.032 H04.122 G24.5 10/15/2014 11 10/15/2014 11 99214 68761 10/15/2014 11 68761 51 E2 E11.9 25 E1 116 58 A, B, D 1 C 1 C 1
ICD-9 to ICD-10 Conversion 365.02 anat. narrow angle glaucoma (A) H40.032 anat. narrow angle glaucoma, left eye 333.81 Blepharospasm (B) G24.5 Blepharospasm [no laterality] 375.15 Tear Film insufficiency (DES) [C] H04.122 Dry Eye Syndrome of left lacrimal gland. 68761-E1 punctal plug insertion upper left [Linked] 68761-E2 punctal plug insertion lower left [Linked] 250.00 DM II, controlled (D) E11.9 DM II, w/o complications 117 Screening Plaquenil and Rheumatoid Arthritis Use Screening for unlisted for codes, High co-management Risk Drug - Plaquenil and unique situations 377.00 Papilledema V58.69 High Risk Med - Plaquenil 714.0 Rheumatoid arthritis 077.3 Other adenoviral conjunctivitis 03/1/2010 11 92225-50 1 03/1/2010 11 99213 2, 3 03/1/2010 11 87809 4 How much should you be paid for 92225-50? RVU is.78; bilateral surgery modifier = 3; 100% per eye; approx. $22.50 per eye. 118
Screening Plaquenil: ICD-10 New Claim Form Screening for High Risk Drug - Plaquenil H47.10 Z79.899 M06.9 B30.1 10/1/2014 11 92225 50 A 10/1/2014 11 99213 B, C 10/1/2014 11 87809 QW D 1 1 1 119 Note: 12 diagnosis codes per claim Diagnosis Pointer is alpha now! Effective April 1 2014 ICD-10 GEMS Crosswalk (from ICD-9) ICD-10 codes ICD-9 ICD-10 Description 377.00 H47.10 Papilledema [no laterality] V58.69 Z79.899 High Risk Med - Plaquenil 714.0 M06.9 Rheumatoid arthritis 077.3 B30.1 Other adenoviral conjunctivitis 120
Questions Jeffrey Restuccio, CPC, CPC-H, MBA Memphis TN (901) 517-1705 jeff@eyecodingforum.com www. 121
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