ICD-10-CM Are You Prepared? Part III Lids to Lens

ICD-10-CM Are You Prepared? Part III Lids to Lens Rebecca H. Wartman OD March 2014 With contributions from Doug Morrow OD & Harvey Richman OD

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

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

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

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

Q&A and After the Webinar AT THE END OF THE PRESENTATION: Questions will be answered at the end of the presentation, as time permits To ask a question: Click on the red arrow to maximize the webinar control panel and expand the Questions section. Type inquiries in the dialog box and press Send AFTER THE WEBINAR Please submit your questions using the online submission form: https://www.aoa.org/ask-thecoding-experts

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

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

Topics for Today Diseases of the eye and adnexa (H00-H59) Overview of Chapter VII Chapter VII General Inclusions and Exclusions- Details Chapter VII Details H00-H05 Disorders of eyelid, lacrimal system, orbit H10-H11 Disorders of conjunctiva H15-H22 Disorders of sclera, cornea, iris, ciliary body H25-H28 Disorders of lens Questions Self Assessment Review Questions Resources With specific coding examples sprinkled throughout presentation

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

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

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

Alphabetical Index Conjunctivitis, viral, adenovirus (372.01) Note that this code is not under the H10 numbering Must find this code in chapter with B codes USE THE ALPHABETICAL INDEX TO LOOK UP CODES

Tabular List: Conjunctivitis, viral, adenovirus B30.1 (372.01) Note the Excludes1 note under heading and note specific code definition NOT PER EYE HERE

Tabular List H00-H28 Code Range Today, again, we will review the following in detail H00-H06 Disorders of eyelid, lacrimal system, orbit H10-H13 Disorders of conjunctiva H15-H22 Disorders of sclera, cornea, iris, ciliary body H25-H28 Disorders of lens

Disorders of eyelid, lacrimal system and orbit (H00-H05) For the entire H00 to H05 section Excludes2: open wound of eyelid (S01.1-) superficial injury of eyelid (S00.1-, S00.2-)

Disorders of eyelid H00 H02.9 Hordeolum (or stye) H00.0 Chalazion H00.1 Blepharitis H01.0 Dermatitis H01.1 Entropion H02.0 Ectropion H02.1 Lagophthalmos H02.2 Blepharochalasis H02.3 Ptosis H02.4 Other disorders affecting eyelid function H02.5 Xanthalasma H02.6 Other and unspecified degenerative disorders H02.7 Other specific disorders of eyelid H02.8 Unspecified disorder of eyelid H02.9

Disorder of Eyelid Exclusions: H00 H02.9 H01.0 Blepharitis Excludes1: blepharoconjunctivitis (H10.5-) H02 Other disorders of eyelid Excludes1: congenital malformations of eyelid (Q10.0-Q10.3) H02.5 Other disorders affecting eyelid function Excludes2: blepharospasm (G24.5) organic tic (G25.69) psychogenic tic (F95.-) H02.8 Other specified disorders of eyelid H02.81 Retained foreign body in eyelid Use additional code to identify the type of retained foreign body (Z18.-) Excludes1: laceration of eyelid with foreign body (S01.12-) retained intraocular foreign body (H44.6-, H44.7-) superficial foreign body of eyelid and periocular area (S00.25-)

Key for Final Digits Required Key for Final Digit for lid specific: 1 = right upper lid 2 = right lower lid 3 = right unspecified lid 4 = left upper lid 5 = left lower lid 6 = left unspecified lid 9= unspecified eye and lid Key for Final Digit for Eye specific: 1 = right eye 2 = left eye 3 = both eyes 9 = unspecified eye

Alphabetical Index: External Hordeolum (397.11) Eye, eyeball, eyelid see condition Sty, stye (external) (internal) (meibomian) (zeisian) see Hordeolum Hordeolum (eyelid) (externum) (recurrent) H00.019 -internum H00.029 --left H00.026 ---lower H00.025 ---upper H00.024 --right H00.023 ---lower H00.022 ---right H00.021 - left H00.016 - - lower H00.015 - - upper H00.014 - right H00.013 - - lower H00.012 - - upper H00.011

Tabular List: Hordeolum, External H00.01 (379.11) Code to specific eye and eyelid when possible and appropriate per Tabular Listing

Alphabetical Index: Blepharitis 373.00 Blepharitis (angularis) (ciliaris) (eyelid) (marginal) (nonulcerative) H01.009 - herpes zoster B02.39 - left H01.006 - - lower H01.005 - - upper H01.004 - right H01.003 - - lower H01.002 - - upper H01.001 - squamous H01.029 - - left H01.026 - - - lower H01.025 - - - upper H01.024 - - right H01.023 - - - lower H01.022 - - - upper H01.021 - ulcerative H01.019 - - left H01.016 - - - lower H01.015 - - - upper H01.014 - - right H01.013 - - - lower H01.012 - - - upper H01.011 Note that H zoster blepharitis is under different code set- B

Tabular List : Blepharitis H01.0 (373.00) Excluses1 Note! REMEMBER: Blepharitis has two other categories: Ulcerative H01.01 and Squamous H01.02

Other Things to Notice in Eyelid Section Trichiasis is separate section for trichiasis without entropion as opposed to entropion broken into unspecified, cicatricial, mechanical, senile and spastic H02.0 Entropian and trichiasis of eyelid H02.05 Trichiasis without entropian H02.051Trichiasis without entropian right upper eyelid H02.052Trichiasis without entropian right lower eyelid H02.053Trichiasis without entropian right eye, unspecified eyelid H02.054Trichiasis without entropian left upper eyelid H02.055Trichiasis without entropian left lower eyelid H02.056Trichiasis without entropian left eye, unspecified eyelid H02.059Trichiasis without entropian unspecified eye, unspecified eyelid Entropion is spelled entropian in this particular entry of CDC official version

Disorders of the Lacrimal System H04 Dacryoadenitis H04.0 Other disorders of lacrimal gland H04.1 Epiphora H04.2 Acute and unspecified inflammation of lacrimal passage H04.3 Chronic Inflammation of lacrimal passages H04.4 Stenosis and insufficiency of lacrimal passages H04.5 Other changes of lacrimal passages H04.6 Other disorders of lacrimal passages H04.8 Disorders of lacrimal system, unspecified H04.9

Lacrimal System Exclusions H04 H04.9 H04 Disorders of the Lacrimal System Excludes1: congenital malformations of lacrimal system (Q10.4-Q10.6) H04.3 Acute and unspecified inflammation of lacrimal passages Excludes1: neonatal dacryocystitis (P39.1) Key point: Congenital conditions are typically under other sections

Alphabetic Index: Dry Eye Syndrome (375.15) Dry, dryness see also condition - larynx J38.7 - mouth R68.2 - - due to dehydration E86.0 - nose J34.89 - socket (teeth) M27.3 - throat J39.2 Keratoconjunctivitis H16.20- sicca (Sjogren's) M35.0- -- not Sjogren's H16.22- Syndrome see also Disease - dry eye H04.12- NO DRY EYE LISTED NO DRY EYE LISTED FINALLY find under syndrome

Tabular List: Dry Eye Syndrome (375.15; 370.33) H04.12 Dry eye syndrome Tear film insufficiency, NOS 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 lacrimal glands H04.129 Dry eye syndrome of unspecified lacrimal gland H16.22 Keratoconjunctivitis sicca, not specified as Sjögren's Excludes1: Sjögren's syndrome (M35.01) H16.221 Keratoconjunctivitis sicca, not specified as Sjögren's, right eye H16.222 Keratoconjunctivitis sicca, not specified as Sjögren's, left eye H16.223 Keratoconjunctivitis sicca, not specified as Sjögren's, bilateral H16.229 Keratoconjunctivitis sicca, not specified as Sjögren's, unspecified eye Note that Dry eye is under lacrimal while Keratitis sicca is under keratitis

Disorders of Orbit H05 Excludes1: congenital malformation of orbit (Q10.7) H05.0 Acute inflammation of orbit H05.1 Chronic inflammatory disorders of orbit H05.2 Exophthalmic conditions H05.3 Deformity of orbit Excludes1:congenital deformity of orbit (Q10.7) H05.4 Enophthalmos hypertelorism (Q75.2) H05.5 Retained(old) forgeign body following penetrating wound of orbit Retrobulbar foreign body Use additional code to identify the type of retained foreign body (Z18.-) Excludes1: current penetrating wound of orbit (S05.4-) Excludes2: retained foreign body of eyelid (H02.81-) H05.8 Other disorders of orbit H05.9 Unspecified disorders of orbit retained intraocular foreign body (H44.6-, H44.7-)

Disorders of conjunctiva (H10 H11) H10.0 Mucopurulent conjunctivits H10.1 Acute Atopic conjunctivitis H10.2 Other acute conjunctivitis H10.3 Unspecified acute conjunctivitis H10.4 Chronic conjunctivitis H10.5 Blepharoconjunctivitis H10.8 Other conjunctivitis H11.0 Pterygium of eye H11.1 Conjunctival degenerations and deposits H11.2 Conjunctival scars H11.3 Conjunctival hemorrhage H11.4 other conjunctival vascular disorders and cysts H11.8 Other specified disorders of conjunctiva H11.9 Unspecified disorder of conjunctiva Each of these subcategories are further divided into right eye, left eye, bilateral or unspecified eye codes

Disorders of Conjunctiva Exclusions-H10 H10 Conjunctivitis Code First Note Excludes1: keratoconjunctivitis (H16.2-) H10.21 Acute toxic conjunctivitis Acute chemical conjunctivitis Code first (T51-T65) to identify chemical and intent Excludes1:burn and corrosion of eye and adnexa (T26.-) H10.3 Unspecified acute conjunctivitis Excludes1: ophthalmia neonatorum NOS (P39.1) H10.44 Vernal conjunctivitis Excludes1: vernal keratoconjunctivitis with limbar and corneal involvement (H16.26-) H10.81 Pingueculitis Excludes1: pinguecula (H11.15-)

Disorders of Conjunctiva Exclusions-H11 H11 Other disorders of conjunctiva Excludes1: keratoconjunctivitis (H16.2-) H 11.0 Pterygium of eye Excludes1: pseudopterygium (H11.81-) H11.1 Conjunctival degenerations and deposits Excludes2: pseudopterygium (H11.81) H11.14 Conjunctival xerosis, unspecified Excludes1: xerosis of conjunctiva due to vitamin A deficiency (E50.0, E50.1) H11.15 Pinguecula Excludes1: pingueculitis (H10.81-)

Alphabetical Index: Conjunctivitis (372.01, 372. 05, 372.13, 372.14) Conjunctivitis (staphylococcal) (streptococcal)nos H10.9 - Acanthamoeba B60.12 - acute H10.3- - - atopic H10.1- - - mucopurulent H10.02- - - - follicular H10.01- - - chemical (see also Corrosion, cornea) H10.21- - - pseudomembranous H10.22- - - serous except viral H10.23- - - - viral see Conjunctivitis, viral - - toxic H10.21- - adenoviral (acute) (follicular) B30.1 - allergic (acute) see Conjunctivitis, acute, atopic Note See also so can follow but optional Note the See so must go to this entry - - chronic H10.45 etc MANY MORE CODES UNDER CONJUNCTIVITIS

Tabular List: Conjunctivitis, acute mucopurulent H10.02- (372.01) Conjunctivitis H10 Excludes1 keratoconjunctivitis (H16.2-) H10.0 Mucopurlent conjunctivitis H10.01 Acute follicular conjunctivits H10.011 Acute folloicular conjunctivitis, right eye H10.012 Acute folloicular conjunctivitis left eye H10.013 Acute folloicular conjunctivitis bilateral H10.019 Acute folloicular conjunctivitis unspecified eye H10.02 Other mucopurulent conjunctivitis H10.021 Other mucopurulent conjunctivitis right eye H10.022 Other mucopurulent conjunctivitis left eye H10.023 Other mucopurulent conjunctivitis bilateral H10.029 Other mucopurulent conjunctivitis unspecified eye Must specify eye when coding conjunctivitis Many other codes for conjunctivitis exist

Disorders of Sclera, cornea, iris and ciliary body H15-H22 H15 Disorders of sclera H16 Keratitis H17 Corneal scars and opacities H18 Other disorders of cornea H20 Iridocyclitis H21 Other disorders of iris and ciliary body H22 Disorders of iris and ciliary body in diseases classified elsewhere This section has more Excludes1 and Excludes 2 Notes along with more Code also and Code first notes

Disorders of sclera and cornea H15-H18 Exclusions and Notes Note how many codes are NOT in the H code series

Alphabetic Index: Keratoconus H18.60- Keratoconus H18.60- - congenital Q13.4 - stable H18.61- - unstable H18.62- Note keratoconus is broken down into congenital, stable and unstable Congenital keratoconus is coded under different code series (Q13.4)

Tabular List: Keratoconus H18.60- (371.61) Note codes are divided into right, left or bilateral Note that Acute hydrops is another term for Keratoconus, unstable

Disorders of iris and ciliary body H20-H22 Exclusions and Notes Note that most exclusions are viral or infective in origin Note cataract is from iridocyclitis is coded in addition

Disorders of iris and ciliary body H20-H22 Exclusions and Notes Hyphema caused by trauma is coded completely differently

Disorders of iris and ciliary body H20-H22 Exclusions and Notes Floppy iris from flomax would need to also code for flomax

Alphabetic Index: Iritis secondary to Herpes Simplex (364.01) Note that herpes simplex iritis is listed under B codes

Tabular List: Iritis secondary to Herpes Simplex (364.01) If look under Tabular for iridocyclitis still guides you to B00.51 Under B00, note the excludes1 and excludes2 Correct codes is here. NOT per eye!

Alphabetic Index: Cataract, Nuclear Sclerotic (366.16) Note the ( ) descriptions are not for senile Under Age related directs you to Cataract, senile If look under nuclear still directed to Cataract, senile, nuclear Finally directed to proper subcatergory range

Tabular List: Cataract, nuclear sclerotic,senile H25.1 (366.16) Make sure you note heading excludes as usual Take care to note 5 digits - just when we figured out the 5 th and 6 th digit nomenclature where 9 was unspecified, 0 is thrown in for unspecified

Summary Until you are very familiar with proper code choice, use both the Alphabetic Index and the Tabular List to choose codes Remember to always read the entire section to understand all Excludes1, Excludes2, Includes, Code with and Also Code notes Remember that some codes are per eyelid, some codes are per eye and some are not specific Take time to convert your current codes for these categories now Disorders of eyelids, lacrimal system and orbit Disorders of conjunctiva Disorders of sclera, cornea, iris, and ciliary body Disorders of lens

Resources CDC ICD-10-CM Official USA site http://www.cdc.gov/nchs/icd/icd10cm.htm 2014 release of ICD-10-CM at bottom of page has all the downloads ICD-10-CM Guidelines [PDF - 512 KB] ICD-10-CM PDF Format ICD-10-CM List of codes and Descriptions (updated 7/3/2013) CMS ICD-10-CM information https://www.cms.gov/medicare/coding/icd10/index.html American Optometric Association www.aoa.org/coding X World Health X Use for general training only-not THE SAME AS AMERICAN SYSTEM http://apps.who.int/classifications/apps/icd/icd10training

Finally Questions?

Review Questions Answers will be posted on EyeLearn 1. Sclera ectasia (H15.84) cannot be coded at the same time as degenerative myopia (H44.2-) True or False 2. Neurotrophic keratoconjunctivitis of right eye can be coded using and be paid. a) H16.23 b) H16.232 c) H16.231 d) H12.239

Review Questions Answers will be posted on EyeLearn 3. Subacute Iritis due to EKC of the right eye is coded with: a) H20.02 b) H20.031 c) H20.013 d) H20.0 4. Traumatic Hyphema of the left eye is coded with: a) H21.02 b) S05.1- c) S05.12 d) H21.022

Review Questions Answers will be posted on EyeLearn 5. A traumatic cataract (not total) of the left eye caused by a baseball hit to the eye is coded with: a) H26.112 and external cause code from Chapter 20 b) H26.132 and external cause code from Chapter 20 c) H26.132 and external cause code from Chapter 7 d) H26.113 and external cause code from Chapter 20 6. In the Alphabetic Index, aphakia is looked up under: a) H25.0- b) Q12.3 c) H27.0- d) B00.6

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