ICD-10 Coding for non-medical Encounters Codes ICD-10 coding for Eyecare Jeffrey Restuccio, CPC, CPC-H, MBA Coding and Billing Consultant specializing in Eyecare Memphis TN (901) 517-1705 jeff@eyecodingforum.com www.eyecodingforum.com EyeCodingForum.com 1 General ICD-10 Concepts for Eyecare ICD-10-CM is an updated system for the reporting of diseases, conditions and other factors affecting healthcare (i.e., injuries and adverse effects). New ICD-10 codes must be used on Oct 1 2014. ICD-10 has 68,000 codes compared to only 13,000 ICD-9 codes. 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. EyeCodingForum.com 2 ECF@eyecodingforum.com 901-517-1705 1
ICD-10 Code Format The format is below. [ ] [ ] [ ]. [ ] [ ] [ ] [ ] Category (letter), etiology, anatomic site, severity and then a seventh-digit "extender" Letter, 2 digits, then up to four digits to the right. Sometimes the sixth digit will be an X placeholder code. Example: H40.11X2 = POAG, moderate stage. Note use of placeholder X code. EyeCodingForum.com 3 Routine Eye Exam The routine exam of eyes code (V72.0) changes to two codes: Z01.00 Encounter for examination of eyes and vision without abnormal findings. Z01.01 Encounter for examination of eyes and vision with abnormal findings. The word routine is no longer in the description. While I would consider abnormal to indicate a medical diagnosis, it is not known how the different carrier, and in particular, the Vision Plans, will define abnormal findings. EyeCodingForum.com 4 ECF@eyecodingforum.com 901-517-1705 2
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] That's all you need to know. But there are exceptions EyeCodingForum.com 5 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 6 ECF@eyecodingforum.com 901-517-1705 3
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 EyeCodingForum.com 7 The ICD-10 X Placeholder Code Occasionally one will find an X character in the middle of an ICD-10 code. T45.0X1A: Accidental poisoning by an anti-allergic drug, right eye, initial encounter. In this case, the X in the fifth-digit position serves as a placeholder so that the sixth and seventh characters are in the correct position. Without the placeholder, the resulting code would be invalid. Note that some ICD-10 Codes begin with an X. The injury codes (T and S) and some glaucoma codes will use the placeholder X code. EyeCodingForum.com 8 ECF@eyecodingforum.com 901-517-1705 4
Occurrence Codes and Sequela 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. 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 EyeCodingForum.com 9 What is GEMS? The General Equivalence Mappings (GEMS) GEMS is a tool that can be used to convert data from ICD-9- CM to ICD-10-CM/PCS and vice versa. http://www.ahacentraloffice.org/ahacentraloffice/shtml/ic Dgem.shtml The following examples are a simple GEMS crosswalk from ICD-9 to ICD-10. While many ICD-10 codes are exact one-to-one crosswalks, there are exceptions. Those exceptions, plus acronyms, different terms for the same disease, and codes that have no ICD-10 crosswalk are what makes the ICD-10 transition challenging. A simple GEMS conversion is inadequate and omits many required codes. EyeCodingForum.com 10 ECF@eyecodingforum.com 901-517-1705 5
Simple GEMS conversion (ICD-9) Rank ICD-9 Description Top 1 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 EyeCodingForum.com 11 Simple GEMS conversion Rank ICD-9 Description Diabetes mellitus without complication type II or 14 25000 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 Top 27 code list from a typical clinic. T The example on the next two slides is a simple GEMS mapping. Only the stage codes are expanded. EyeCodingForum.com 12 ECF@eyecodingforum.com 901-517-1705 6
ICD10 H52229 H5213 H524 H5203 H2510 H40059 H25019 H4011X3 H4011X0 H4011X2 H4011X4 H4011X1 H01009 D3120 GEMS ICD-10 Crosswalk (1 of 2) 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 13 ICD10 H1033 H1133 H00019 E119 H25049 H04129 H3530 H35369 H40009 H40039 H4010X3 H4010X0 H4010X2 H4010X4 H4010X1 H10409 GEMS ICD-10 Crosswalk (2 of 2) 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 14 ECF@eyecodingforum.com 901-517-1705 7
H52.***: 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 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 15 Hyperopia Hypermetropia = hyperopia=farsightedness. Patient can see in the distance. Eyeball is too short. H52.00 Hypermetropia, unspecified eye [exception] H52.01 Hypermetropia, right eye H52.02 Hypermetropia, left eye H52.03 Hypermetropia, bilateral Emmetropia: normal refractive status. EyeCodingForum.com 16 ECF@eyecodingforum.com 901-517-1705 8
Myopia 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 17 Presbyopia Inability to see close-up (reading, over 40) H52.4 Presbyopia [No Laterality] EyeCodingForum.com 18 ECF@eyecodingforum.com 901-517-1705 9
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 19 H52.2 **: Astigmatism Regular astigmatism: principal meridians are perpendicular. Irregular astigmatism: principal meridians are not perpendicular. With-the-rule astigmatism: the vertical meridian is steepest (football lying on its side) (more common w/ children). Against-the-rule astigmatism: the horizontal meridian is steepest (football standing on its end) (more common w/ adults). H52.201 Unspecified astigmatism, right eye [KOD*] [Laterality] H52.211 Irregular astigmatism, right eye [Laterality] H52.221 Regular astigmatism, right eye [Laterality] *Kiss of Death means you may be denied if you use too many unspecified codes (carrier specific) EyeCodingForum.com 20 ECF@eyecodingforum.com 901-517-1705 10
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 21 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 22 ECF@eyecodingforum.com 901-517-1705 11
H52.5**: Ophthalmoplegia and Accommodation Disorders Internal ophthalmoplegia is characterized by paresis of ciliary body with loss of power of accommodation and pupil dilatation 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 EyeCodingForum.com 23 Common Signs and Symptoms H43.391: Floaters, right eye [Laterality] H53.16: Halos H53.8: Blurred Vision (Other visual disturbances) H57.9: Red Eyes H57.11: Eye pain, right [Laterality] I10: Hypertension essential, benign, malignant. Floaters: Disorders of vitreous body: other vitreous opacities Halo: is a hazy ring around bright lights seen by some patients with refractive error or optical defects, (e.g., cataracts, or corneal swelling). EyeCodingForum.com 24 ECF@eyecodingforum.com 901-517-1705 12
Other Visual Disturbances No Laterality and not coded By Eye. H53.10 Unspecified subjective visual disturbances H53.16 Psychophysical visual disturbances H53.19 Other subjective visual disturbances H53.2 Diplopia and double vision H53.8 Other visual disturbances H53.9 Unspecified visual disturbance These are considered signs and symptoms and most (all) carriers will not pay linked to an office visit. EyeCodingForum.com 25 Common Signs and Symptoms Avoid the unspecified code if possible. R11.0 Nausea R11.10 Vomiting, unspecified R11.11 Vomiting without nausea R11.2 Nausea with vomiting, unspecified H21.561 Non-Reactive Pupil [pupillary abnormality] [right eye] EyeCodingForum.com 26 ECF@eyecodingforum.com 901-517-1705 13
Some 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. 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. Z83.511 Family history of glaucoma Z83.518 Family history of other specified eye disorder Z85.840 Personal history of malignant neoplasm of eye Personal history of (corrected) congenital Z87.720 malformations of eye EyeCodingForum.com 27 Common Signs and Symptoms R51: Headache (Recommend not reporting) Too many types and options to fully discuss in this presentation. 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 my complete course. Here are some useful tips for documentation headaches today. EyeCodingForum.com 28 ECF@eyecodingforum.com 901-517-1705 14
Headaches 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 29 Types of Headaches Tension headaches (G44.2**) are the most common and due to muscle tension and stress. [unspecified, episodic, and chronic) Migraine headaches 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 30 ECF@eyecodingforum.com 901-517-1705 15
Screening Codes Screening for long-term use of a high-risk drug (ICD-9: V58.69) Report Z79.899 for Plaquenil use for rheumatoid arthritis. 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). EyeCodingForum.com 31 More Family History and Status Codes 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 Z94.7 Corneal transplant status EyeCodingForum.com 32 ECF@eyecodingforum.com 901-517-1705 16
All the Eyecare Medical Diagnoses Are discussed in-depth in the EyeCodingForum.com comprehensive six-hour ICD-10 Coding for Eyecare course. It is recorded and can be viewed just like a video and paused or rewound at any time. It is a per clinic fee and videos can be watched any time until Oct 1 2014. It includes PowerPoint slides with narration. Visit the www.eyecodingforum.com website for more information and to order. For more information contact ecf@eyecodingforum.com or call at 901-517-1705. EyeCodingForum.com Presentation Created by Jeffrey Restuccio, CPC, CPC-H, MBA 33 ICD-10 Coding for non-medical Encounters Codes ICD-10 coding for Eyecare Jeffrey Restuccio, CPC, CPC-H, MBA Coding and Billing Consultant specializing in Eyecare Memphis TN (901) 517-1705 jeff@eyecodingforum.com www.eyecodingforum.com EyeCodingForum.com 34 ECF@eyecodingforum.com 901-517-1705 17