Transitioning to ICD-10-CM: General Coding Guidelines & Mapping 2
Introduction 1975 - International Classification of Diseases, 9th revision was originated 1979 - The United States began using ICD-9 1990 - The World Health Organization (WHO) endorsed ICD-10-CM 1994 - Other Countries began adopting ICD-10-CM 1996 - Health Insurance Portability and Accountability Act (HIPAA) added provisions for the standardization of healthcare information, including standards for electronic claims, provider Identifiers, privacy and code sets Health and Human Service (HHS) began working on developing recommendations that meet the HIPAA requirements 1999 - The United States partially adopted ICD-10 for mortality reporting Most countries are currently using ICD-10 today
Final Rule for Adoption On January 15, 2009, the HHS released the final regulations to move from the current ICD- 9- CM coding system to the ICD- 10- CM coding system beginning October 1, 2013. On April 9, 2012, DHHS released a proposed rule to push back the implementation of ICD- 10 one year. The new effective date will allow those on the industry who have not yet begun to prepare the time needed to transition to ICD- 10- CM. On April 1, 2014, a bill was passed containing language that stated the department of Health and Human Services Secretary is not permitted to adopt ICD- 10 before October 1, 2015
ICD-10-CM Implementation October 1, 2015 is the scheduled implementation date ICD-10 will replace ICD-9 as mandated by the Health Insurance Portability and Accountability Act (HIPAA) for diagnoses and inpatient procedure coding Only ICD-10 codes can only be submitted with dates of service of October 1, 2015 and after ICD-9 codes must still be submitted for dates of service of September 30, 2015 and prior
ICD-10-CM Implementation Strategy Outline your implementation plan ICD-10 will impact how both the business and clinical practices are managed Identify processes that need updating and reorganizing Pinpoint where diagnosis codes are used through the practice Identify who will be part of the team, their roles and training needs Identify the Top 20 ICD-9 codes and map to the ICD-10-CM equivalent Begin practicing internally with the ICD-10 codes Improve clinical documentation for increased specificity Engage your vendors and payers Engage Payers on how they will be making the ICD-10 translation and how it will affect your reimbursement
ICD-10 Implementation Understand how your software is translating and/or selecting ICD-10-CM codes within EHR system. Are enough codes loaded into your system, or will additional codes need to be added. Will additional pick lists need to be added or changed for ICD-10 Test your systems, both internally and externally
ICD-10-CM Changes There are multiple changes in store: Expanded injury codes by site of the injury Creation of combination diagnosis/symptom codes Greater specificity in code assignment (up to seven characters) ICD-10-CM codes are alphanumeric and include all letters except U
Conventions for the ICD-10-CM The general rules for use of the classification are independent of the guidelines. These conventions (general rules) are incorporated within the Alphabetic Index and Tabular List as instructional notes The Alphabetic Index Alphabetic Diseases and Injuries Index Neoplasm Table Table of Drugs and Chemicals External Causes Index Notes appear in the Alphabetic Index to: Define terms Provide direction Provide coding instructions
Tabular List of Diseases and Injuries The Tabular List The Tabular List is broken down into 21 Chapters based on body system or condition (color coded by chapter) Contains categories, subcategories and codes All categories are 3 characters There are multiple chapters used for coding eye disease and conditions (these chapters are in bold print) Chapter 7 Disorders of the eye and adnexa will be the primary chapter used for eye care
Structure & Function! ICD-9 codes are 3 to five digits, primary using numeric digits
Structure & Format! ICD-10-CM has up to seven digits. The first digit is always an alpha. The second digit is always numeric, and the others remaining five digits can be a combination. 12
Structure & Format The first three characters are alphanumeric and is defined by the category or health condition The fourth character further defines the site, etiology, and manifestation, or state of the disease or condition The fifth and sixth characters sub- classification represents the most accurate level of specificity. This addition may identify more specificity regarding the patient s condition or diagnosis. Placeholder character X Placeholder character X is used as a fifth or sixth character at certain six or seven character codes to allow for future expansion. Placeholder X holds the seventh character in the seventh character position for any code that requires it that is less than six characters in length. Where a placeholder exists, the X must be used in order for the code to be considered a valid code.
Structure & Format Seventh character extension Certain categories have applicable 7 th characters. The 7 th characters when required must always be the 7 th character in the data field. If a code that requires a 7 th character is not 6 characters in length, a placeholder X must be used to fill in the empty character. Occurrence codes: A Initial encounter D Subsequent encounter S Sequela (late effect) Example: T15.01 - Foreign body in cornea T15.01XA - Foreign body of cornea, right eye, initial encounter T15.01XD - Foreign body in cornea, right eye, subsequent encounter T15.01XS - Foreign body in cornea, right eye, sequela
Abbreviations NEC Not elsewhere classifiable This abbreviation in the Alphabetic Index represents other specified. When a specific code is not available for a condition the Alphabetic Index directs the coder to the other specified code in the Tabular List NOS Not otherwise specified This abbreviation is the equivalent of unspecified
Punctuation [ ] Brackets are used in the Tabular List to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the Alphabetic Index to identify manifestation codes. ( ) Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplemental words that do not affect the code number. The terms within the parentheses are referred to as nonessential modifiers. : Colons are used in the Tabular List after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category
Other and Unspecified Codes Other Codes Codes titled other or other specified are for use when the information in the medical record provides detail for which a specific code does not exist. Alphabetic Index entries with NEC in the line designate other codes in the Tabular List. These Alphabetic Index entries represent specific disease entities for which no specific code exists so the term is included within an other code. Unspecified Codes Codes titled unspecified are for use when the information in the medical record is insufficient to assign a more specific code. Documentation does not include enough information to code with level of specificity required by the code. For those categories for which an unspecified code is not provided, the other specified code may represent both other and unspecified.
Language/Terms Use of and When the word and is used in a narrative statement it represents and/or. Use of with The word with should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. Use of see and see also The see instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the see note to locate the correct code. A see also instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the see also note when the original main term provides the necessary code. Use of Code also note A code also note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction
Language/Terms Includes Notes This note appears immediately under a three-character code title to further define, or give examples of, the content of the category Inclusion Terms List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of other specified codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Language/Terms! Default Codes A code listed next to a main term in the ICD-10-CM Alphabetic Index is referred to as a default code. The default code represents that condition that is most commonly associated with the main term, or is the unspecified code for the condition. If a condition is documented in a medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned. * Do not code directly from the default code indicated
Excludes Notes Excludes Notes The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other Excludes1 A type 1 Excludes note is a pure excludes note. It means, NOT CODED HERE! An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Example: E11 Type 2 diabetes Excludes1: gestational diabetes (O24.4-) Type 1 diabetes (E10.-)
Excludes Notes Excludes2 A type 2 Excludes note represents Not included here. An excludes2 note 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. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Example: I10 Essential (primary) hypertension Includes: high blood pressure hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) Excludes2: essential (primary) hypertension involving vessels of brain (I60-I69) essential (primary) hypertension involving vessels of eye ( H35.0)
General Coding Guidelines
Level of Detail in Coding Diagnosis codes are to be used and reported at the highest number of characters available ICD-10-CM codes are composed of codes with 3, 4, 5, 6 or 7 characters Codes with 3 characters are the heading of a category of codes that may be furthers subdivided by the use of 4th and/or 5th characters and/or 6th characters, providing greater detail. 3 characters are used only when it is not further subdivided A code is invalid if it has not been coded to the full number of characters required, including the 7th character if applicable
Locating a Code To select a code in the classification that corresponds to a diagnosis or reason for visit documented in a medical record, first locate the term in the Alphabetic Index, and then verify the code in the Tabular List. Read and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular List. It is essential to use both the Alphabetic Index and Tabular List when locating and assigning a code. The Alphabetic Index does not always provide the full code. Selection of the full code, including laterality and any applicable 7 th character can only be done in the Tabular List. A dash (-) at the end of an Alphabetic Index entry indicates that additional characters are required. Even if a dash is not included at the Alphabetic Index entry, it is necessary to refer to the Tabular List to verify that no 7th character is required.
Laterality Laterality For bilateral sites, the final character of the codes in the ICD-10-CM indicates laterality. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. The right side is usually character 1 The left side is usually character 2. In those cases where a bilateral code is provided the bilateral character is usually 3 The unspecified side is either a character 0 or 9 depending on whether it is a fifth or sixth character *There are codes found in ICD-10-CM that break this laterality concept (E1, E2, E3, E4)
Signs and Symptoms Signs and Symptoms Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) contains many, but not all codes for symptoms. Use of Sign/Symptom/Unspecified Codes Sign/symptom and unspecified codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter
Multiple Coding for a Single Condition In addition to the etiology/manifestation convention that requires two codes to fully describe a single condition that affects multiple body systems, there are other single conditions that also require more than one code. Use additional code notes are found in the Tabular List at codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. The sequencing rule is the same as the etiology/manifestation pair, use additional code indicates that a secondary code should be added. Code first notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a code first note and an underlying condition is present, the underlying condition should be sequenced first. Example: H42 Glaucoma in disease classified elsewhere
Acute and Chronic Conditions If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first. In ICD-10-CM both codes for the acute and chronic condition would be reported if there is no combination code.
Combination Code A combination code is a single code used to classify Two diagnoses or A diagnosis with an associated secondary process (manifestation) A diagnosis with an associated complication Combination codes are identified by referring to subterm entries in the Alphabetic Index and by reading the inclusion and exclusion notes in the Tabular List. Assign only the combination code when that code fully identifies the diagnostic conditions involved or when the Alphabetic Index so directs. Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code Example: E11.321 Type 2 diabetes with mild nonproliferative diabetic retinopathy
Sequela (Late Effect) Sequela (Late Effect) A sequela (or late effect ICD-9 term) is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, or it may occur month or years later, such as a previous injury. Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second. An exception to the above guidelines are those instances where the code for the sequela is followed by a manifestation code identified in the Tabular List and title, or the sequela code has been expanded (at the fourth, fifth or sixth character levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect.
Reporting Same Diagnosis Code More than Once Reporting Same Diagnosis Code More than Once Each unique ICD-10-CM diagnosis code may be reported only once for an encounter. This applies to bilateral conditions when there are no distinct codes identifying laterality or two different conditions classified to the same ICD-10- CM diagnosis code. If no bilateral code is listed, and the condition is bilateral, assign separate codes for both the left and right side.
Principal or First-Listed Diagnosis Code Principal or First-Listed Diagnosis Code If no sequencing instructions apply, then sequencing is based on the condition that brought the patient into the physicians office, and for which the condition was the primary focus of treatment. Conditions present at the time that treatment was received, but do not meet the definition of principal diagnosis, should be coded as additional codes.
Previous Conditions Previous Conditions Some physicians include in the diagnostic statement resolved conditions or diagnoses and status-post procedures from previous visits that have no bearing on the current treatment. Such conditions are not to be reported and coded only for internal documentation use or policy.
Mapping & Coding
Locating a Code Alphabetic Index to Diseases and Injuries select a code in the classification that matches the a diagnosis or reason for visit documented in the medical record Then verify in the Tabular List Read and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular Lists Select the full code including laterality and any applicable 7th character from the Tabular List
Vision Examination V72.0 Examination of eyes and vision
Vision Examination V72.0 Examination of eyes and vision Z01.00 Encounter for examination of eyes and vision without abnormal findings Z01.01 Encounter for examination of eyes and vision with abnormal findings (ICD-9 V-codes will be found in Chapter 21 (Z00-Z99)
Chapter Specific Coding Guidelines! In addition to general coding guidelines there are guidelines for specific diagnoses and/or conditions in the classifications. Unless otherwise indicated, these guidelines apply to all health care settings. Please refer to Section II for guidelines on the section of principal diagnosis.
Chapter 7 Disorders of the Eye and Adnexa (H00-H59) (page 528)! H00-H05 Disorders of eyelids, lacrimal system and orbit! H10-H13 Disorders of conjunctiva! H15-H21 Disorders of sclera, cornea, iris and ciliary body! H25-H28 Disorders of lens! H30-H36 Disorders of choroid and retina! H40-H42 Glaucoma! H43-H45 Disorders of vitreous body and globe! H46-H46 Disorders of optic nerve and visual pathways! H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction! H53-H54 Visual disturbances and blindness! H55-H59 Other disorders of eye and adnexa
Myopia 367.1 Myopia
Myopia 367.1 Myopia H52.1 Myopia H52.10 - Myopia, unspecified H52.11 - Myopia, right eye H52.12 - Myopia, left eye H52.13 - Myopia, bilateral
Hyperopia 367.0 Hyperopia
Hyperopia 367.0 Hyperopia H52.0 Hypermetropia H52.00 - Hypermetropia, unspecified eye H52.01 - Hypermetropia, right eye H52.02 - Hypermetropia, left eye H52.03 - Hypermetropia, bilateral
Cornea 370.01 Marginal Corneal Ulcer
Cornea 370.01 Marginal Corneal Ulcer H16.04 - Marginal corneal ulcer H16.041 Marginal corneal ulcer, right eye H16.042 Marginal corneal ulcer, left eye H16.043 Marginal corneal ulcer, bilateral H16.049 Marginal corneal ulcer, unspecified eye
Cornea 918.1 Superficial injury of cornea
Cornea 918.1 Superficial injury of cornea S05.00 - Injury of conjunctive and cornea abrasion without foreign body S05.00XA Injury of conjunctiva and cornea abrasion without foreign body, unspecified eye S05.01XA Injury of conjunctiva and cornea abrasion without foreign body, right eye S05.02XA Injury of conjunctiva and cornea abrasion without foreign body, left eye
Conjunctiva 372.01 Serous conjunctivitis, except viral
Conjunctiva 372.01 Serous conjunctivitis, except viral H10.23 - Serous conjunctivitis, except viral H10.231 Serous conjunctivitis, except viral, right eye H10.232 Serous conjunctivitis, except viral, left eye H10.233 Serous conjunctivitis, except viral, bilateral H10.239 Serous conjunctivitis, except viral, unspecified
Conjunctiva 372.14 Other chronic allergic conjunctivitis
Conjunctiva 372.14 Other chronic allergic conjunctivitis eye eye bilateral H10.45 Other chronic allergic conjunctivitis H10.41 Chronic giant papillary conjunctivitis H10.411 Chronic giant papillary conjunctivitis, right H10.412 Chronic giant papillary conjunctivitis, left H10.413 Chronic giant papillary conjunctivitis, H10.419 Chronic giant papillary conjunctivitis, unspecified eye
Eyelid - Blepharitis 373.00 Blepharitis, unspecified
Eyelid - Blepharitis 373.00 Blepharitis, unspecified H01.00 - Unspecified blepharitis H01.001 Unspecified blepharitis right upper eyelid H01.002 Unspecified blepharitis right lower eyelid H01.003 Unspecified blepharitis right eye, unspecified eyelid H01.004 Unspecified blepharitis left upper eyelid H01.005 Unspecified blepharitis left lower eyelid H01.006 Unspecified blepharitis left eye, unspecified eyelid H01.009 Unspecified blepharitis unspecified eye, unspecified eyelid
Eyelid - Hordeolum 373.11 Hordeolum externum 372.12 Hordeolum internum
Eyelid - Hordeolum 373.11 Hordeolum externum H00.011 - Hordeolum externum right upper eyelid H00.012 - Hordeolum externum right lower eyelid H00.013 - Hordeolum externum right eye, unspecified eyelid H00.014 - Hordeolum externum left upper eyelid H00.015 - Hordeolum externum left lower eyelid H00.016 - Hordeolum externum left eye, unspecified eyelid H00.019 - Hordeolum externum unspecified eye, unspecified eyelid 372.12 Hordeolum internum H00.021 - Hordeolum internum right upper eyelid H00.022 - Hordeolum internum right lower eyelid H00.023 - Hordeolum internum right eye, unspecified eyelid H00.024 - Hordeolum internum left upper eyelid H00.025 - Hordeolum internum left lower eyelid H00.026 - Hordeolum internum left eye, unspecified eyelid H00.029 - Hordeolum internum unspecified eye, unspecified eyelid
Chapter 7 - Specific Coding Guidelines 1) Assigning Glaucoma Codes Assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, the affected eye, and the glaucoma stage. 2) Bilateral glaucoma with same type and stage. When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage. When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not 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. 3) Bilateral glaucoma stage with different types or stages When a patient has bilateral glaucoma and each eye is documented as having a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma. When a patient has bilateral glaucoma and each eye is documented as having a different type, and the classification does not distinguish laterality (i.e. subcategories H40.10, H40.11 and H40.20), assign one code for each type of glaucoma with the appropriate seventh character for the stage. When a patient has bilateral glaucoma and each eye is documented as having the same type, but different stage, and the classification does not distinguish laterality (i.e. subcategories H40.10, H40.11 and H40.20), assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye.
Chapter 7 - Specific Coding Guidelines 4) Patient admitted with glaucoma and stage evolves during the admission If a patient is admitted with glaucoma and the stage progresses during the admission, assign the code for highest stage documented. 5) Indeterminate stage glaucoma Assignment of the seventh character 4 for indeterminate stage should be based on the clinical documentation. The seventh character 4 is used for glaucomas whose stage cannot be clinically determined. This seventh character should not be confused with the seventh character 0, unspecified, which should be assigned when there is no documentation regarding the stage of the glaucoma.
Glaucoma 365.11 Primary Open angle glaucoma
Glaucoma 365.11 Primary Open angle glaucoma 0 = stage unspecified 1 = mild stage 2 = moderate stage 3 = sever stage 4 = indeterminate stage H40.11 - Primary open- angle glaucoma (7th) 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
Glaucoma 365.22 Acute angle- closure glaucoma
Glaucoma 365.22 Acute angle- closure glaucoma 0 = stage unspecified 1 = mild stage 2 = moderate stage 3 = sever stage 4 = indeterminate stage H40.21 - Acute angle- closure glaucoma (7th) H40.211 Acute angle- closure glaucoma, right eye H40.212 Acute angle- closure glaucoma, left eye H40.213 Acute angle- closure glaucoma, bilateral H40.219 Acute angle- closure glaucoma, unspecified eye
Glaucoma 365.12 Low Tension open- angle glaucoma
Glaucoma 365.12 Low Tension open- angle glaucoma 0 = stage unspecified 1 = mild stage 2 = moderate stage 3 = sever stage 4 = indeterminate stage H40.12 - Low tension glaucoma (7th) H40.121 Low tension glaucoma, right eye H40.122 Low tension glaucoma, left eye H40.123 Low tension glaucoma, bilateral H40.129 Low tension glaucoma, unspecified eye
Glaucoma 365.23 Chronic angle- closure glaucoma
Glaucoma 365.23 Chronic angle- closure glaucoma 0 = stage unspecified 1 = mild stage 2 = moderate stage 3 = sever stage 4 = indeterminate stage H40.22 - Chronic angle- closure glaucoma (7th) H40.221 Chronic angle- closure glaucoma, right eye H40.222 Chronic angle- closure glaucoma, left eye H40.223 Chronic angle- closure glaucoma, bilateral H40.229 Chronic angle- closure glaucoma, unspecified eye
Iris 364.01 Primary iridocyclitis 364.02 Recurrent iridocyclitis
Iris 364.01 Primary iridocyclitis H20.01 - Primary iridocyclitis H20.011 - Primary iridocyclitis, right eye H20.012 - Primary iridocyclitis, left eye H20.013 - Primary iridocyclitis, bilateral H20.019 - Primary iridocyclitis, unspecified eye 364.02 Recurrent iridocyclitis H20.02 - Recurrent acute iridocyclitis H20.021 - Recurrent acute iridocyclitis, right eye H20.022 - Recurrent acute iridocyclitis, left eye H20.023 - Recurrent acute iridocyclitis, bilateral H20.029 - Recurrent acute iridocyclitis, unspecified eye
Lacrimal 375.15 Tear film insufficiency, unspecified
Lacrimal 375.15 Tear film insufficiency, unspecified H04.12 - Dry eye syndrome of lacrimal gland H04.121 Dry eye syndrome of right lacrimal gland H04.122 Dry eye syndrome of left lacrimal gland H04.123 Dry eye syndrome of bilateral glands H04.129 - Dry eye syndrome of unspecified gland *Tear film insufficiency, NOS
Lacrimal 375.32 Acute dacryocystitis
Lacrimal 375.32 Acute dacryocystitis H04.32 - Acute dacryocystitis H04.321- Acute dacryocystitis, right lacrimal gland H04.322 - Acute dacryocystitis, left lacrimal gland H04.323 - Acute dacryocystitis, bilateral lacrimal glands H04.329 - Acute dacryocystitis, unspecified lacrimal gland
Lens 366.14 Posterior subcapsular polar senile cataract 366.16 Senile nuclear sclerosis
Lens 366.14 Posterior subcapsular polar senile cataract H25.04 - Posterior subcapsular polar age-related cataract H25.041 Posterior subcapsular polar age-related cataract, right eye H25.042 Posterior subcapsular polar age-related cataract, left eye H25.043 Posterior subcapsular polar age-related cataract, bilateral H25.049 Posterior subcapsular polar age-related cataract, unspecified 366.16 Senile nuclear sclerosis H25.1 - Age-related cataract H25.10 Age- related cataract, unspecified H25.11 Age-related cataract, right eye H25.12 Age-related cataract, left eye H25.13 Age-related cataract, bilateral
Muscle 368.2 Diplopia 378.01 Monocular esotropia 378.11 Monocular extropia 378.83 Convergence insufficiency or palsy
Muscle 368.2 Diplopia H53.2 - Diplopia 378.01 Monocular esotropia H50.011 - Monocular esotropia, right eye H50.012 - Monocular esotropia, left eye 378.11 Monocular extropia H50.111 - Monocular extropia, right eye H50.112 - Monocular extropia, left eye 378.83 Convergence insufficiency or palsy H51.11 Convergence insufficiency
Posterior Segment 362.02 Proliferative diabetic retinopathy E08.351 Diabetic mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema E08.359 Diabetic mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema E09.351 Drug chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema E09.359 Drug chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema E13.351 Other specified diabetic mellitus with proliferative diabetic retinopathy with macular edema E13.359 Other specified diabetic mellitus with proliferative diabetic retinopathy without macular edema
Posterior Segment 362.04 Mild nonproliferative diabetic retinopathy E08.321 Diabetic mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema E08.329 Diabetic mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema E09.321 Drug chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E09.329 Drug chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E13.321 Other specified diabetic mellitus with mild nonproliferative diabetic retinopathy with macular edema E13.359 Other specified diabetic mellitus with mild nonproliferative diabetic retinopathy without macular edema
Posterior Segment 362.05 Moderate nonproliferative diabetic retinopathy E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E13.331 Other specified diabetic mellitus with moderate nonproliferative diabetic retinopathy with macular edema E13.339 Other specified diabetic mellitus with moderate nonproliferative diabetic retinopathy without macular edema 362.06 Severe nonproliferative diabetic retinopathy E11.341 Type 2 diabetic mellitus with severe nonproliferative diabetic retinopathy with macular edema E11.349 Type 2 diabetic mellitus with severe nonproliferative diabetic retinopathy without macular edema E13.341 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E13.349 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
Next Steps Once the top 20 code are translations from ICD-9 to ICD-10 begin working with the new codes internally Start by practicing with the new codes Study the specific coding guidelines for these codes Practice asking the questions to get the level of specificity required by each type of exam or service Once you are comfortable with the top 20 codes, move on to additional codes Practice setting up Test cases (software updates complete) Engage your payers and vendors Plan and begin testing
Contact Information teri@pecaa.com (503) 670-9200 Webinar - June 25, 2015 at 12:00pm pst Instruction packet will be available on the PECAA website Links to recommended ICD-10-CM books see PECAA website