ICD-10 for Optometry and Ophthalmology - Microsoft · PDF fileICD-10 for Optometry and...

ICD-10 for Optometry and Ophthalmology

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ICD-10 for Optometry and Ophthalmology

Written and Presented by:Jeffrey Restuccio CPC, CPC-H, MBA

From a Declaration of Principles jointly adopted by a Committee of the American Bar Association and a committee of Publishers.

Any opinions, findings, recommendations or conclusions expressed by the author(s)or speaker(s) do not necessarily reflect the views of Cross Country Education, LLC. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with

the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advise or other expert assistance is required, the services of a competent professional person should be sought.

Copyright 2014 Jeffrey Restuccio & Cross Country Education, LLC. No part of this workbook may be reproduced in any manner without the expressed written consent of Jeffrey Restuccio & Cross Country Education, LLC.

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ICD-10 for Ophthalmology and Optometry Jeffrey Restuccio, CPC, CPC-H, MBA House Rules

Be sure to write the Seminar Number and your Registration Number on the red Evaluation Sheet at the back of your manual.

You must fill out the red Evaluation Sheets at the back of your Manual before

you leave. Be sure to include your E-mail address and fill out the back portion.

There will be two 15-minute breaks. We will take 1 hour for lunch.

Please include your E-mail address if you want to receive updates from me concerning ICD-10 for Eyecare as well as general Ophthalmology and Optometry coding and billing.

This course will include clinical information for the coding and billing staff and

documentation and coding guidelines for the providers. In addition, we may have specialists in the room. My goal will be to accommodate everyone and keep the class moving. This class is interactive so I plan for at least one hour of discussion. Please be courteous as there will be those new to coding as well as those with twenty years of experience.

If you are a clinical professional, either an Optometrist or an Ophthalmologist,

please understand that I must cover medical terminology and describe the different diseases and conditions for the billing and coding personnel.

If you are a coding expert please understand I must cover fundamental coding

concepts for those new to coding.

If you have a complicated, specific question on a question or payment issue, please write it out, or better yet, send it to me in an E-mail to [email protected]

You can pick up your certificate for CEU’s after you submit the Evaluation

Form.

Yes, I perform documentation and coding audits, either remote or onsite. I also do practice assessments. If you are interested in a proposal, please contact me via E-mail [email protected] or 901-517-1705.

Introduction to ICD-10Eye Anatomy

Introduction to ICD-10Eye Anatomy

Jeffrey Restuccio, CPC, CPC-H, MBAEyeCodingForum.com(901)[email protected]

Jeffrey Restuccio, CPC, CPC-H, MBAEyeCodingForum.com(901)[email protected]

A Little about Me

• I have been teaching coders, billers and providers for over 15 years.

• I have help certified over 1,000 coders.

• I also audit thousands of medical records.

• I have been teaching a live EyeCare coding, billing, and documentation course since 2007; in all, I have taught well over 200 live classes and have hundreds of students nationwide. I teach bothcoding and billing and ICD-10 for Eyecare.

EyeCodingForum 2

1

Importance of Eye Anatomy

• For proper ICD-9, CPT and surgical coding you need to know:

• The Anterior Segment

• The Posterior Segment

• The External Ocular Adnexa of the Eye

• This is how the CPT manual is arranged and segments are referenced often.

EyeCodingForum 3

Anatomy of the Eye

Segments are not Chambers

The eyeball is divided into three chambers:

1. Anterior Chamber: lies between the cornea and the iris

2. Posterior Chamber: lies between the iris and the lens.

3. Vitreous chamber: lies between the lens and the back of the retina.

The first two are the anterior segment; the third the posterior segment.

The eyeball is divided into three chambers:

1. Anterior Chamber: lies between the cornea and the iris

2. Posterior Chamber: lies between the iris and the lens.

3. Vitreous chamber: lies between the lens and the back of the retina.

The first two are the anterior segment; the third the posterior segment.

EyeCodingForum 4

2

Anatomy of the Eye

Anterior Segment includes:

CorneaCornea

Anterior chamberAnterior chamber

Anterior scleraAnterior sclera

Ciliary bodyCiliary body

LensLens

IrisIris

EyeCodingForum 5

Anatomy of the Eye

Anterior SegmentCornea

The anterior (front) portion of the outer layer of the eye made of fibrous, transparent tissue that extends over the pupil. Its main function is to refract rays of light so that they are properly focused on the receptor cells found in the posterior region of the eye.

The anterior (front) portion of the outer layer of the eye made of fibrous, transparent tissue that extends over the pupil. Its main function is to refract rays of light so that they are properly focused on the receptor cells found in the posterior region of the eye.

EyeCodingForum 6

3

Anatomy of the Eye

Cornea has five layers:

EyeCodingForum 7

The cornea has five layers (anterior to posterior):

1. Epithelium2. Bowman s layer.3. Stroma4. Descemet membrane5. Endothelium

Anatomy of the EyeAnterior Segment -- Anterior chamber

The space between the cornea and the iris of the eye.The space between the cornea and the iris of the eye.EyeCodingForum 8

4

Anatomy of the EyeAnterior Segment -- Anterior chamber angle

Formed by the inner cornea and the root of the iris.

1. The Trebecular meshwork: responsible for draining the aqueous humor from the eye via the anterior chamber

2. Schlemms Canal: a set of tubes that allows fluid to drain into the blood system.

Both structures are critical to understanding glaucoma and its treatment.

Formed by the inner cornea and the root of the iris.

1. The Trebecular meshwork: responsible for draining the aqueous humor from the eye via the anterior chamber

2. Schlemms Canal: a set of tubes that allows fluid to drain into the blood system.

Both structures are critical to understanding glaucoma and its treatment.

EyeCodingForum 9

Anatomy of the Eye

Anterior Segment -- Iris – ciliary body

Iris: Colored portion of the eye which surrounds the pupil.Ciliary body: secrets aqueous fluid; controls shape of lens.Iris: Colored portion of the eye which surrounds the pupil.Ciliary body: secrets aqueous fluid; controls shape of lens.EyeCodingForum 10

5

Anterior Segment

Zonules

Zonules of Zinn: are a ring of fibrous strands, called firbillin, connecting the ciliary body with the lens. Mutations can lead to Marfans Syndrome.

Zonules of Zinn: are a ring of fibrous strands, called firbillin, connecting the ciliary body with the lens. Mutations can lead to Marfans Syndrome.

EyeCodingForum 11

Anatomy of the Eye

Anatomy of the Eye

Anterior Segment - Lens

A transparent structure that rests behind the pupil consisting of an inner nucleus and an outer cortex which is surrounded by a cellophane-type capsule. The lens focuses light rays into images on the retina.

A transparent structure that rests behind the pupil consisting of an inner nucleus and an outer cortex which is surrounded by a cellophane-type capsule. The lens focuses light rays into images on the retina.EyeCodingForum 12

6

Anatomy of the Eye

Posterior Segment includes:

Vitreous HumorVitreous Humor

Retina

Choroid

Retina

Choroid

ScleraSclera

MaculaMacula

EyeCodingForum 13

Anatomy of the Eye

Posterior Segment – Vitreous Humor

The clear, jelly-like substance found behind the lens that maintains the shape of the eyeball.The clear, jelly-like substance found behind the lens that maintains the shape of the eyeball.EyeCodingForum 14

7

Anatomy of the Eye

Posterior Segment – Fovea / Macula Lutea

Age-Related Macular Degeneration ARMD is the leading cause of blindness in the US. EyeCodingForum 15

Anatomy of the Eye

Posterior Segment – Fovea / Macula Lutea

EyeCodingForum 16

8

Anatomy of the Eye

Posterior Segment - Retina

The light-sensitive, inner layer of the eye that contains receptor cells called rods and cones.The light-sensitive, inner layer of the eye that contains receptor cells called rods and cones.

EyeCodingForum 17

Anatomy of the Eye

Posterior Segment – Other Layers

EyeCodingForum 18

These structures are between the choroid and the anterior surface of the retina.• Bruch's membrane• Pigment epithelial cells are like a row of bricks laying on

Bruch's membrane.• Photoreceptors (rods, dim light and cones, bright light and

visual acuity)• 7 or 8 layers of nerve tissue lie above the photoreceptors.

Image on next slide.

9

Anatomy of the Eye

Posterior Segment – Other Layers

The retina has many layers, not just one. The retina has many layers, not just one.

EyeCodingForum 19

Anatomy of the Eye

Posterior Segment - Choroid

The choroid is the layer of the eye behind the retina that contains major blood vessels. The choroid feeds the retina.The choroid is the layer of the eye behind the retina that contains major blood vessels. The choroid feeds the retina.

EyeCodingForum 20

10

Anatomy of the Eye

Posterior Segment - Sclera

The sclera, or white of the eye. It is the tough, opaque tissue that serves as the eye's protective outer coat.The sclera, or white of the eye. It is the tough, opaque tissue that serves as the eye's protective outer coat.

EyeCodingForum 21

Anatomy of the Eye

External Ocular Adnexa - Orbit

A protective house for the eyes, blood vessels, nerves and extraocular muscles.A protective house for the eyes, blood vessels, nerves and extraocular muscles.

EyeCodingForum 22

11

Anatomy of the Eye

• Orbital walls – Seven bones

Frontal bone: Top partZygomatic bone: roofLacrimal bone: medial wallEthmoid bone: medial wallMaxillary bone: orbital floor (subject to blowout fracture.)Sphenoid bone: back of the orbitPalatine bone: middle of the orbit

EyeCodingForum 23

Orbital Bones

The seven bones that articulate to form the orbit.

yellow = Frontal bonegreen = Lacrimal bonebrown = Ethmoid boneblue = Zygomatic bonepurple = Maxillary boneaqua = Palatine bonered = Sphenoid bone Latin orbitae

How do you Code a Rule-Out of a Blowout fracture? Blowout Fracture

EyeCodingForum 24

12

Anatomy of the Eye

External Ocular Adnexa - Eyelids

Protect the vulnerable surface of the eye from trauma and drying.Protect the vulnerable surface of the eye from trauma and drying.

EyeCodingForum 25

Anatomy of the Eye

Ocular Adnexa - Conjunctiva

A thin, transparent membrane that lines the eyelids and coats the anterior portion of the eyeball over the white of the eye.

A thin, transparent membrane that lines the eyelids and coats the anterior portion of the eyeball over the white of the eye. EyeCodingForum 26

13

Anatomy of the Eye

External Ocular Adnexa: Conjunctiva - Lacrimal system

Structures that secrete tears. Note that there is an inferior and a superior punctum.Structures that secrete tears. Note that there is an inferior and a superior punctum.EyeCodingForum 27

Anatomy of the Eye

Rectus muscles; insert at the sclera, behind the limbus. These musclesMove the eye up or down or at an angle.

1. Superior2. Inferior3. Medial rectus – all three controlled by the oculomotor nerve (III)4. Lateral rectus – controlled by abducens (VI) nerve

• Six Eye muscles: 4 rectus; 2 oblique

Oblique muscles; insert at the sclera, behind the limbus. These move the eye horizontally, right or left.

1. Superior Oblique2. Inferior Oblique

Mostly responsible for rotation of the eye sideways.EyeCodingForum 28

14

Optic Nerve

• The optic nerve, also called cranial nerve II, transmits visual information from the retina to the brain.

• Glaucoma, optic neuritis, optic nerve hypoplasia, trauma and anterior optic neuropathy are common diseases that impact the optic nerve.

EyeCodingForum 29

Example of Anatomy and Coding (1)

• 65280 Repair of laceration; cornea ... not involving "uveal tissue“ (estimated Medicare allowable amount is $648 [RVU = 10.9])

• 65285 Repair of laceration; cornea ... with ... "uveal tissue“(estimated Medicare allowable amount is $1065 [RVU = 18.07).

• If the coder never asks and the surgeon never documents that “uveal tissue” was involved, then this procedure will never be reported correctly. The difference is $417!

• Where and what exactly is the uvea?

EyeCodingForum 30

The uvea is the: iris, ciliary body and the choroid. These are all contiguous structures of the eye.

15

Example of Anatomy and Coding (2)

• Codes 17106 to 17111 are destruction codes that reference a "cutaneous vascular proliferative lesion.”

• The RVU (relative value unit) for 17106 is 10.09; approximate payment (2013) in TN is $314.32.

• The RVU for 11440 (excision…benign lesion…eyelids….5 cm or less) is 4.09; approximate payment (2013) in TN is $126.56.

• That’s a significant difference!• If the coder never asks and the surgeon never documents the

specific term “cutaneous vascular proliferative lesion” then these procedures will never be reported correctly.

EyeCodingForum 31

Cutaneous Vascular Proliferative Lesion

• One term is hemagioma.• Another term is “Port Wine Stain.” This could be on their

face and eyelid.• Another term is a strawberry birthmark.

EyeCodingForum 32

16

Lens Codes

• You will see these terms a lot in ICD-10• Anterior Subcapsular: The front portion of the

capsule that contains the nucleus and cortex of the lens.

• Posterior Subcapsular: the back portion• Cortical: the cortex of the lens• Nuclear: the nucleus of the lens• Please try to avoid, “Cataract, unspecified.”

EyeCodingForum 33

Eye Anatomy Summary

• Know the Anterior Segment

• Know the Posterior Segment

• Know the External Adnexa of the Eye

• Be able to relate eye anatomy to both ICD-9 diagnostic codes and CPT procedural codes.

• Always ask your provider if you are unclear about eye anatomy.

EyeCodingForum 34

17

Introduction to ICD‐10 coding for Eyecare

Jeffrey Restuccio, CPC, CPC‐H, MBACoding and Billing Consultant specializing in Eyecare

Memphis TN(901) 517‐1705

[email protected]

EyeCodingForum.com 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.


18

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.


HIPAA Non‐Covered Entities

• All Health Insurance Portability and Accountability Act (HIPAA) of 1996 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.

• Includes: 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.


19

Why upgrade to ICD‐10?

The International Association of Industrial Accident Boards and Commissions stakeholders will certainly identify ways to use this information in new and powerful ways:

• Allow for much greater specificity and accuracy in diagnosis.

• 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.


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.


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ICD‐10 Code Format• [ ] [ ] [ ]. [ ] [ ] [ ] [ ] Category (letter), etiology, anatomic site,

severity and then a seventh‐digit "extender"


B20 Human immunodeficiency virus [HIV] diseaseD3132 Benign neoplasm of left choroidE119 Type 2 diabetes mellitus without complicationsH0011 Chalazion right upper eyelidH4011X1 Primary open‐angle glaucoma, mild stageH5211 Myopia, right eyeH524 PresbyopiaR51 HeadacheT1502XA Foreign body in cornea, left eye, initial encounterZ961 Presence of intraocular lens

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.


21

Won’t my Billing System do all of this for me?

• 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?

• The simple answer is “No.” The reasons include: lack of crosswalk of some codes, lack of complete definitions, lack of acronyms and common terminology, lack of enhanced descriptions and explanations, and lack of coding guideline information.

• Plus, 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.


Learn ICD‐9 Guidelines Now!

• 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. 5th‐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)


22

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.


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.


23

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.


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.


24

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.

Avoid unspecified:

• Diabetes Mellitus Astigmatism

• Keratoconus Cataracts

• Headaches Keratitis

• ARMD Conjunctivitis

• Entropion Adverse effects

• Ectropion Reason and location of accidents

• Lagophthalmos Epiphora


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 time‐consuming 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.


25

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).


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*)


26

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.


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.]


27

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

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


28

Lacrimal Gland Codes

• Lacrimal Gland Codes (1,2,3, 9) map to RT, LT, bilateraland 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

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 disturbancesH53.16 Psychophysical visual disturbancesH53.19 Other subjective visual disturbancesH53.8 Other visual disturbancesH53.9 Unspecified visual disturbance

29

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.


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 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

• Note: all above are for the right eye; fifth digit = 1.


30

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.

•


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.

• The best example of a sequela is a rust ring.

• 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


31

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 withabnormal findings.

• It will be very important to monitor how insurance companies reimburse based on the two ICD‐10 codes linked to office visits.


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.


32

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.


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.

33

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

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.

34

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]

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]

35

Ophthalmoplegia

• Ophthalmoplegia (Ophthalmoparesis) or ophthalmoplegiarefers to weakness or paralysis of one or more extraocularmuscles 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.


Ophthalmoplegia

H49.30 Total (external) ophthalmoplegia, unspecified eyeH49.31 Total (external) ophthalmoplegia, right eyeH49.32 Total (external) ophthalmoplegia, left eyeH49.33 Total (external) ophthalmoplegia, bilateral

H49.40Progressive external ophthalmoplegia, unspecified eye

H49.41 Progressive external ophthalmoplegia, right eyeH49.42 Progressive external ophthalmoplegia, left eyeH49.43 Progressive external ophthalmoplegia, bilateral


Note how a zero (fifth digit) indicates an unspecified eye(exception).

36

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 eyeH52.521 Paresis of accommodation, right eyeH52.531 Spasm of accommodation, right eye

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.


37

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 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.


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.

• 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.


38

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.


Z85.840 Personal history of malignant neoplasm of eye

Z87.720Personal history of (corrected) congenital malformations of eye

Z82.1 Family history of blindness and visual loss

Z83.511 Family history of glaucomaZ83.518 Family history of other specified eye disorder

Z94.7 Corneal transplant status

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.

39

What is GEMS? • The General Equivalence Mappings (GEMS)• http://www.ahacentraloffice.org/ahacentraloffice/shtml/ICDgem.sh

tml• 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.


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.


40

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.


Simple GEMS conversion (ICD‐9)

• Top 27 code list from a typical clinic.


Rank ICD‐9 Description

1 36721 Regular Astigmatism

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

41

Simple GEMS conversion

• Top 27 code list from a typical clinic.

• T


Rank ICD‐9 Description

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 Common description

H52229 Astigmatism, Regular, unsp eye

H5213 Myopia, bilat

H524 Presbyopia

H5203 Hypermetropia, bilat

H2510 Cat, a/r nuclear unsp eye

H40059 hypertension, Ocular unsp eye

H25019 Cat, Cortical a/r unsp eye

H4011X3 Glauc, POAG , severe stage

H4011X0 Glauc, POAG , stage unsp

H4011X2 Glauc, POAG , moderate stage

H4011X4 Glauc, POAG , indeterminate stage

H4011X1 Glauc, POAG , mild stage

H01009 Blepharitis, unsp unsp eye, unsp eyelid

D3120 Bngn neoplsm Unsp retina


42

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 eyeEyeCodingForum.com 51

Glaucoma

H40.001 Preglaucoma, unspecified, right eye

H40.002 Preglaucoma, unspecified, left eye

H40.003 Preglaucoma, unspecified, bilateralH40.009 Preglaucoma, unspecified, unspecified eye


Glaucoma Suspect: Laterality Only. No stage. All four codes are listed. This is a six‐digit code.

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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-10365.70 glaucoma stage, unspec 0365.71 glaucoma stage, mild 1365.72 glaucoma stage, moderate 2365.73 glaucoma stage, severe 3365.74 glaucoma stage, indeterminate stage 4

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 unspecifiedH40.11X1 Primary open‐angle glaucoma, mild stageH40.11X2 Primary open‐angle glaucoma, moderate stageH40.11X3 Primary open‐angle glaucoma, severe stage

H40.11X4 Primary open‐angle glaucoma, indeterminate stage

44

GEMS CrosswalkPseudoexfoliation 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 stageICD‐9: 365.52 Pseudoexfoliation glaucoma andICD‐9: 365.73 Severe stage glaucoma [two codes]

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

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 stage3 H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage4 H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage5 H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage

6 H40.1420 Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified7 H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage8 H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage9 H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage

10 H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage11 H40.1430 Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified12 H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage13 H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage

14 H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage15 H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage16 H40.1490 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, stage unspecified17 H40.1491 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage

18 H40.1492 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, moderate stage19 H40.1493 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, severe stage20 H40.1494 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate


45

Macula and ARMD


ICD-9 Description ICD-10 code and description362.51 ARMD dry H35.31 ARMD dry [No Laterality]362.52 ARMD wet H35.32 ARMD wet [No Laterality]

362.57 DrusenH35.361 Drusen (degenerative) of macula, right eye [Laterality]

377.21 Drusen, optic disc

H47.321 Drusen of the optic disc, right eye. [Laterality]

Diabetes Is Not Coded By Eye

• E10.*** Type 1 DM

• E11.*** 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 Non‐Insulin Dependent Diabetes Mellitus (IDDM). The are inaccurate and archaic.


46

Diabetes


• ICD‐9 Fourth digit = 0, no manifestation

8 codes (typically not reported by many clinics) plus manifestation codeNo manifestation

250.00 DM II, controlled =>E11.9 Type 2 diabetes mellitus without complications

250.01 DM I, controlled =>E10.9 Type 1 diabetes mellitus without complications

250.02 DM II, uncontrolled =>E11.65 Type 2 diabetes mellitus with hyperglycemia

250.03 DM I, uncontrolled =>E10.65 Type 1 diabetes mellitus with hyperglycemia

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

47

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.

ICD‐10 DM Type 1 w/ Eye Manifestation (1 of 2)

E10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema

E10.319Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

E10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy withmacular edema

E10.329Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy withoutmacular edema

E10.331Type 1 diabetes mellitus with moderate nonproliferativediabetic retinopathy withmacular edema

E10.339Type 1 diabetes mellitus with moderate nonproliferativediabetic retinopathy withoutmacular edema


48

ICD‐10 DM Type 1 w/ Eye Manifestation (2 of 2)

E10.341Type 1 diabetes mellitus with severe nonproliferativediabetic retinopathy withmacular edema

E10.349Type 1 diabetes mellitus with severe nonproliferativediabetic retinopathy withoutmacular edema

E10.351Type 1 diabetes mellitus with proliferative diabeticretinopathy withmacular edema

E10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy withoutmacular edema

E10.36 Type 1 diabetes mellitus with diabetic cataract

E10.39Type 1 diabetes mellitus with other diabetic ophthalmic complication


Type II follows the same pattern except E11.*** and not E10.***

List with short descriptions (12 codes)


ICD‐10 Short Description

E10311 DMT1 w/ prl db ret w/o mac edem

E10319 DMT1 w/ unsp DM ret w/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/ unsp DM ret w/o mac edem

E10339 DMT1 w/mod non‐prl db ret w/mac edem

E10341 DMT1 w/mod non‐prl db ret w/o mac edem

E10349 DMT1 w/sev non‐prl db ret w/mac edem

E10351 DMT1 w/ prol db ret w/o mac edem

E10359 DMT1 w/ prol db ret w/mac edem

E1036 DMT1 w/ db cataract

E1039 DMT1 w/ db cataract w/ oth ophth compl

49

Cataracts – Age‐Related


366.12 Senile cataract: incipient cataract

H25.091 Other age‐related incipient cataract, right eye

366.13 Senile cataract: ant. subcapsular polar senile cataract

H25.031 Anterior subcapsular polar age‐related cataract, right eye.

366.14 Senile cataract: post subcapsular polar senile cataract

H25.041 Posterior subcapsular polar age‐related cataract, right eye

366.15 Senile cataract: cortical senile cataract

H25.011 Cortical age‐related cataract, right eye

366.16 Senile cataract: nuclear sclerosis

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 presenilecataract: anterior subcapsular polar cataract

H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye

Post subs

366.02 “”: posterior subcapsularpolar cataract

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

50

After‐cataract Codes

• After‐cataracts (posterior capsular opacity) are a type of cataract that forms after surgery for other eye problems, such as glaucoma. 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:

• Cataracts that are the result of chronic steroid use.

• Posterior subcapsular and polar cataract types.

• Prior history of chronic iritis.

• History of diabetes.

• Incomplete cataract removal.


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: after‐cataract: not obscuring vision

H26.491 Other secondary cataract, right eye [one code]

366.53 Cataract: after‐cataract: obscuring vision

H26.491 Other secondary cataract, right eye [same code as above]

51

Congenital Codes

• Examples of a unspecific ICD‐10 crosswalk.


743.32 Congenital cataract and lens anomalies: cortical and zonular cataract

Q12.0 Congenital cataract

743.33 Congenital cataract and lens anomalies: nuclear cataract


743.30 Congenital cataract and lens anomalies: congenital cataract, unspecified


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 involvement

H15.041 Scleritis with corneal involvement, right 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

52

Aphakia Crosswalk to ICD‐10379.31 Aphakia and other disorders

of lens: aphakiaH27.01 aphakia, right eye

379.32 Aphakia and other disorders of lens: subluxation of lens

H27.111 Subluxation of lens, right eye

379.33 Aphakia and other disorders of lens: anterior dislocation of lens

H27.121 Anterior dislocation of lens, right eye

379.34 Aphakia and other disorders of lens: posterior dislocation of lens

H27.131 Posterior dislocation of lens, right eye

379.39 Aphakia and other disorders of lens: other disorders of lens

H27.8 Other specified disorders of lens

743.35 Congenital cataract and lens anomalies: congenital aphakia

Q12.3 Congenital aphakia

743.36 Congenital cataract and lens anomalies: anomalies of lens shape

Q12.4 Spherophakia OR Q12.8 Other congenital lens malformations


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 trichiasisof 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

53

Trauma codes

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]


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.

Foreign body, right eye T codes

• “1” = right eye. Seventh digit wildcard character * is the occurrence code (A, D, or S)


T15.01X* Foreign body in cornea, right eyeT15.11X* Foreign body in conjunctival sac, right eye

T15.81X* Foreign body in other and multiple parts of external eye, right eye

T15.91X* Foreign body on external eye, part unspecified, right eye

54

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 NauseaR11.10 Vomiting, unspecifiedR11.11 Vomiting without nauseaR11.2 Nausea with vomiting, unspecified

Common Signs and Symptoms

368.00 amblyopia, unspecified H53.001 Unspecified amblyopia, right eye368.2 diplopia H53.2 diplopia [no laterality]379.91 eye pain H57.11 Ocular pain, right eye368.15 Halo, photopsia H53.19 other subjective visual disturbances

(halo)368.10 subj visual disturbance H53.10 Unspecified subjective visual

disturbances368.11 sudden visual loss H53.131 Sudden visual loss, right eye368.12 transient visual loss H53.121 Transient visual loss, right eye368.13 Visual discomfort H53.141 Visual discomfort, right eye368.14 Visual distortion of shape

and sizeH53.15 Visual distortion of shape and size [no laterality]

435.9 TIA G45.9 TIA


55

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

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 conjunctivitis375.15 tear film insufficiency, H04.121 Dry eye syndrome of right

lacrimal gland360.31 hypotony [Reduced

tension or pressure]H44.441 Primary hypotony of right eye

346.00 migraine headache G43.109 Migr w/ aura, not intr, w/o S.M.

377.01 papilledema H47.11 papilledema224.6 choroidal nevus D31.31 Benign neoplasm of right

choroid

56

ICD‐9 Screening Codes• Report a screening for current long‐term use of a high‐risk

drug with V58.69.

• Report V67.51 for an exam following completed treatment with high‐risk medication NEC.

• Report 714.0 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‐9 code is: E931.4. This code is specifically for this substance.


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 high‐risk 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.


57

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 self‐harm

T37.2X3* Poisoning by antimalarials and drugs acting on other blood protozoa, assault

T37.2X4* Poisoning by antimalarials and drugs acting on other blood protozoa, undeter

T37.2X5* Adverse effect of antimalarials and drugs acting on other blood protozoa

T37.2X6* Underdosing of antimalarials and drugs acting on other blood protozoa

These are often called “poisoning” codes. The Underdosing term and concept is new to ICD‐10.

* Represents the occurrence codes: A, D or S

Introduction to ICD‐10 for Eyecare

• That’s a lot of information for an Introduction!

• In this course we will review ICD‐10 codes of over 100 diseases and conditions sequentially and in‐depth.

• In addition to specifically eye conditions we will review many associated conditions.

• While there is some duplication, that is a good thing as there are numerous new concepts that must be learned and memorized.


58

Introduction to ICD‐10 coding

Jeffrey Restuccio, CPC, CPC‐H, MBAMemphis TN

(901) 517‐[email protected]


59

1

Claim Form ExamplesICD-10 for EyeCare

By Jeffrey Restuccio, CPC, CPC-HEyeCodingForum.com Memphis TN(901) [email protected]

EyeCodingForum.com2

The following claim forms will illustrate

First we will show the ICD-9 codes The we will discuss documentation issues Then convert to ICD-10 codes. Includes E & M codes/920x2 and 920x4 codes. Diagnostic CPT codes Modifiers 24, 25 Linking / Medical Necessity Tying it all together.

60

Yes, there is a new claim form

EyeCodingForum.com3

Note: 12 diagnosis codes per claimDiagnosis Pointer is alpha now !

Effective April 1 2014

4

Co-Management – Cataract Surgery – First Eye

Use for unlisted codes, co-management and unique situations

366.16 Nuclear Cataract - Senile

11 110/15/2012

Assumption Date: 10/15/2012 Relinquish Date: 1/10/2013

66984 -55 -LT

Dr. Gregory House

Units1

NPI Number

61

5

Co-Management – Cataract Surgery – ICD-10


H25.12 Age-related nuclear cataract, left eye

11 110/15/2015

Assumption Date: 10/15/2012 Relinquish Date: 1/10/2013

66984 55 -LT

Dr. Gregory House

Units1

NPI Number

Co-Management

Link the ICD-10 left eye cataract code to the left eye cataract surgery code.

ICD-10 will not change how CPT and HCPC codes are reported. Linking will be more precise and the linking identifiers will be alphabetic characters and not numbers.

EyeCodingForum.com6

H25.12 Age-related nuclear cataract, left eye

66984 -55 -LT

62

RVU’s 2014 (LA CA)E & M Total RVU Medicine

ExamTotal RVU

99202 2.0899203 3.02 92002 2.3299204 4.64 92004 4.2299205 5.7899212 1.2299213 2.04 92012 2.4399214 3.01 92014 3.5299215 4.03


Medicare Allowable 2014 (LA CA) CF: $35.822E & M Total Medicine

ExamTotal

99202 $81.4699203 $117.59 92002 $91.6299204 $179.36 92004 $165.9999205 $223.0399212 $48.0799213 $79.63 92012 $96.0299214 $117.26 92014 $138.7599215 $156.62


63

9

Punctal Plugs: ICD-9


365.02 anat. narrow angle glaucoma

11 1, 2, 410/15/2012 99214 25

Units

1

1

1

NPI Number

10/15/2012

375.15 DES

368761 E1

10/15/2012

11

11 68761 51 E2 3

MOD-51 is added to second procedure on other eyelid.

333.81 blepharospasm 250.00 DM Type II, controlled

10

Punctal Plugs: ICD-10

H40.032

11 A, B, D10/15/2014 99214 25 111

NPI Number

10/15/2014

G24.5

C68761 E1

10/15/2014

11

11 68761 51 E2 C

H04.122 E11.9

64

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

EyeCodingForum.com11

12

92015 and a medical Dx


365.11 POAG

11

1, 410/15/2012 92014 25

Units

1

1

1

NPI Number

375.15 DES

366.13 Senile Cataract

92015 IS paid by many private medical plans if the ICD-9 code is a medical Dx and not refraction. Paid on cataract Dx.Is 92014 allowed? With MOD-25?

10/15/2012

10/15/2012

11

11

1, 4

3

92083

92015

365.72 Moderate stage

65

13

92015 and a Medical Dx: ICD-10


H40.20X2 POAG moderate stage

11

110/15/2012 99213 25

Units

1

1

1

NPI Number

H04.123 DES of bilateral lacrimal glands

H25.033 Age-Related Cataract

92015 IS paid by many private medical plans if the ICD-9 code is a medical Dx and not refraction. Paid on cataract.

10/15/2012

10/15/2012

11

11

1

3

92083

92015

92015 linked to a medical Dx

1. H40.20X2 POAG moderate stage 2. H04.123 DES of bilateral lacrimal glands 3. H25.033 anterior subcapsular polar age-related

cataract, bilateral eyes Remember, the documentation comes first; converting to

the ICD-10 codes and reporting is second.


66

15

Corneal Abrasion & glaucoma (contacts)


365.12 Low tension glaucoma

11 110/15/2012 99213 25

Units

1

1

1

10/15/2012

918.1 corneal abrasion

292071 50

10/15/2012

11

11 92285 3

364.04 2nd iritis

Anterior Segment Photography is inherently bilateral

16

Corneal Abrasion: ICD-10


H40.123 Low tension glauc bilateral

11 110/15/2014 99213 25

Units

1

1

1

10/15/2014

S05.01XA corneal abrasion, right eye, init

2, 392071 50

10/15/2014

11

11 92285 4

H20.043 2nd iritis, non-infect

S05.02XA Corneal abrasion, left eye, init

There is no bilateral S05.**** code option. Must list each eye separately.

67

Corneal abrasion ICD-10 H40.123 Low tension glaucoma bilateral S05.01XA Injury of conjunctiva and corneal abrasion

without foreign body, right eye, initial encounter S05.02XA Injury of conjunctiva and corneal abrasion

without foreign body, left eye, initial encounter Choose one or the other below: H20.033 Secondary infectious iridocyclitis, bilateral H20.043 Secondary noninfectious iridocyclitis, bilateral

There is no S** “bilateral eyelid” code. You must list both.



99212-24 1

366.23372.02

A patient who is being followed by her Ophthalmologist during the post-op of cataract surgery comes in for an additional visit because she has developed conjunctivitis. The conjunctivitis is unrelated to the cataract surgery and necessitated an additional visit over and above her regular post-op check-ups. The E/M code for the visit is billed to the insurance carrier with a -24 modifier and the diagnosis code used is 372.02 for Acute Conjunctivitis.

Modifier - 24

Allows the physician to report an E & M service was performed during a postoperative or global period for a reason(s) unrelated to the original procedure.

MOD- 24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period

68


99212-24 1

366.23 Traumatic cataract: partially resolved

372.02 Acute conjunctivitis: acute follicular

Modifier – 24: ICD-9

10/15/2012 11


99212-24 1

H26.121 Traumatic cataract: partially resolved RIGHT

H10.012 Acute conjunctivitis: acute follicular, LEFT


10/15/2014 11

69


1. H10.012 Acute conjunctivitis: acute follicular, LEFT eye2. H26.121 Traumatic cataract: partially resolved RIGHT

eye

The cataract code does not even need to be reported here. It could be omitted.



67938-E199213-25

A patient is seen in the office for evaluation of his glaucoma and diabetes has a metal shard embedded in his eyelid. The physician performs an expanded, problem-focused history and examination of his chronic illnesses and performs a foreign body removal of the eyelid. Note the use of the eyelid modifier (E1 = upper left)

Modifier - 25

365.11

1

E914

E849.3374.89

2

Indicates that on a day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E&M service above and beyond the usual preoperative and postoperative care associated with the procedure that was performed.

Mod- 25 Significant Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

70


67938-E1

99213-25


365.11 POAG E914 FB in adnexa

E919.3 metalworking tools374.89 Other disorders of eyelid:

12

10/15/2012

10/15/2012

11

11

We are missing two codes: the location of the accident and the glaucoma stage code on this form.


365.11 POAG need stage code365.73 Severe stage glaucoma

H40.20X3 POAG severe stage [no laterality]

ICD-10: First code the POAG

71


Foreign Body Coding

T15.11XA right eye[lid] (conjunctival sac) [FB eyelid], initial occurrence [this is not an eyelid code].FB embeddedT15.81XA Foreign body on other and multiple parts of external, right eye, initial occurrence.FB superficialS00.25XA would be FB superficial eye[lid]FB retained [incorrect code]H02.814 Upper left eyelid


Accident Coding

ICD-9 Reason: E919.3 Accidents caused by machinery: metalworking machinesICD-10 Reason: W31.1XXA Contact with metalworking machines, initial encounter

ICD-9 Location: E849.3 factoryICD-10 Location: Y92.63 Factory as the place of occurrence of the external cause

72

27

Eye Exam and 92015 on same day


V72.0 routine Vision Exam

11 110/15/2012 92004

Units

1

1

NPI Number

367.0 hyperopia

Bill 92004 linked to V72.0; bill 92015 linked to hyperopia. Private carrier. Not Medicare

10/15/2012 11 92015 2

28

Eye Exam and 92015 on same day: ICD-10


Z01.00 Exam Eye, w/o abn

11 110/15/2014 92004

Units

1

1

NPI Number

H52.03 Hyperopia, bilateral

Bill 92004 linked to Z01.00; bill 92015 linked to hyperopia. Private carrier. Not Medicare

10/15/2014 11 92015 2

73

Eye Exam and 92015 on same day: ICD-10


Z01.00 Exam Eye, w/o abnormal finding H52.03 Hyperopia, bilateral

30

Screening – Plaquenil and Rheumatoid Arthritis


92225 -50

377.00 Papilledema

11 103/1/2010

99213 03/1/2010 11

V58.69 High Risk Med - Plaquenil

714.0 Rheumatoid arthritis

2, 3

03/1/2010 11

077.3 Other adenoviral conjunctivitis

87809 4

Screening for High Risk Drug - Plaquenil

How much should you be paid for 92225-50?

RVU is .78; bilateral surgery modifier = 3;100% per eye; approx. $22.50 per eye.

74

Note: 12 diagnosis codes per claimDiagnosis Pointer is alpha now !

31

Screening – Plaquenil: ICD-10 New Claim Form

92225 50

H47.10

11 A10/1/2014

9921310/1/2014 11

Z79.899 M06.9

B, C

10/1/2014 11

B30.1

87809 QW D

Screening for High Risk Drug - Plaquenil

1

1

1

EffectiveApril 1 2014

GEMS Crosswalk

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

75

Pachymetry - 76514For conditions below, payment frequency will be no more the once every six months, bilaterally. 1. Disorders of endothelial cell function 2. Disorders of corneal thickness 3. Corneal transplantation

For glaucoma, payment is once-per-lifetime.


34

Pachymetry – ABN and MOD-GA


371.57 endothelial corneal dystrophy

11 110/15/2012 76514 GA

Units

1

NPI Number

76514 should be paid on ICD-9 code above. However, have patient sign an ABN and append GA anyway.

76

35

Pachymetry – ICD-10


H18.51 endothelial corneal dystrophy

11 110/15/2014 76514 GA

Units

1

NPI Number

Pachymetry


ICD-9: 371.57 endothelial corneal dystrophy ICD-10: H18.51 endothelial corneal dystrophy[There is no laterality to this code]

77

ICD-9 to ICD-10 Crosswalk: Pachymetry LCD Crosswalk

37123 H1811 Bullous keratopathy, rt eye37120 H1820 Corneal edema, unspec37148 H18461 Periph corneal degen, rt eye37157 H1851 Endothelial corneal dystrophy37160 H18601 Keratoconus, unspec, rt eye37161 H18611 Keratoconus, stable, rt eye37162 H18621 Keratoconus, unstable, rt eyeV4561 Z9841 Cat extract status, right eyeV4569 Z9883 Filt (vitreous) bleb aft glauc surgery status


Other ICD-10 codes that are not “once per lifetime”


92132 – Anterior Segment OCT

Anterior segment OCT is rapidly becoming a valuable tool for managing some glaucoma patients.

Assess angle structure in glaucoma patients with narrow or suspicious angles.

Ability to perform scans in the dark. Use OCT as a complement to gonioscopy.

78


92132 – Anterior Segment OCT

Get an ABN waiver signed in case of denial. Append MOD-GA to the CPT code. More carriers may pay on this in 2014. Several Medicare Jurisdictions pay on it.

365.02 Anatomical narrow angle

40

92132 – Anterior Segment OCT – ICD-9


365.02 Anatomical narrow angle glaucoma

11 110/15/2013 92132

Units

1

NPI Number

92132 is now paid by several Medicare carriers. Be sure your ICD-9 code supports medical necessity

79

41

92132 – Anterior Segment OCT – ICD-10


H40.033, Anatomical narrow angle glaucoma bilateral

11 110/15/2015 92132

Units

1

NPI Number

92132 – Anterior Segment OCT ICD-10 Code H40. 033, Anatomical narrow angle glaucoma bilateral


80


Summary

Everyone must get involved. Conduct audits Work on documentation now. Learn the basics. Decide how codes are selected Review ICD-10 codes now and then in more

detail in Aug and September.

44

Claim Form ExamplesICD-10 for EyeCare

By Jeffrey Restuccio, CPC, CPC-HEyeCodingForum.com Memphis TN(901) [email protected]

81

ICD‐10Coding Additional Required Codes




Do I have 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 of always reporting 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.


82

Infections

• Use additional code Z16.* to identify resistance to drugs


A54.30 Gonococcal infection, eye, unspecifiedA54.31 Gonococcal conjunctivitisA54.32 Gonococcal iridocyclitisA54.33 Gonococcal keratitisA54.39 Gonococcal eye infection, other

“Resistance to” codes

• Select Z16.* codes


Z1611 Resistance to penicillinsZ1621 Resistance to vancomycinZ1624 Resistance to multiple antibioticsZ1631 Resistance to antiparasitic drug(s)Z1632 Resistance to antifungal drug(s)Z1633 Resistance to antiviral drug(s)Z1639 Resistance to other specified antimicrobial drug

83

HIV

• Code first HIV complications of pregnancy, childbirth etc. O98.7*.

• Use additional code to identify manifestations of HIV (where applicable).


B20 HIV

H35.81 Retinal edema [Cotton wool spots] [example] [no laterality]

Histoplasmosis

B39 Histoplasmosis …. [fungus inhaled early in life]

Code manifestations

endocarditis (I39)

meningitis (G02)

pericarditis (I32)

retinitis (H32) [Ocular Histoplasmosis Syndrome]


Code first AIDS (B20)Use additional code for any associated manifestations.

The fungus locates in the lungs and choroid. Goal is to prevent choroidal neovascularization (CNVM).

84

Diabetes

Category Short DescriptionE08.3** DM due to underlying conditions …

E08.35*DM due to underlying condition with proliferative diabetic retinopathy

E08.9 DM due to underlying conditions w/o complicationsE11.3** DM T2 w/ diab retinopathy…E13.3** DM, other specified…with ophthalmic complications

EyeCodingForum.com

Use additional code to identify insulin use Z79.4: Long‐Term Use

Diabetes

Category Short DescriptionE11.36 DM T2 w/ db cataractE11.39 DM T2 w/ oth db oph condE11.649 DM T2 w/ hypoglycemia w/out comaE11.65 DM T2 w/ hyperglycemiaE11.69 DM T2 w/ other specified complicationsE11.9 DM T2 w/o complications

EyeCodingForum.com

Use additional code to identify insulin use Z79.4: Long‐Term Use

85

Other Diabetes

• Use additional code to identify manifestation (H40‐H42)

• Does not apply to Type 1, 2, drug‐induced, or any other specified diabetes.


E13.9 Other specified DM w/o complications

Metabolic Disorders

E64.1 Sequelae of vitamin A deficiency*

Code first condition resulting from sequela of malnutrition and other nutritional deficiencies.

E83.01 Wilson's disease Code also associated KayserFleisher ring (H18.04*)


*Examples: keratoconjunctivitis sicca, staphyloma (H15.8**),night blindness, or leukoma.

86

Metabolic Disorders, more

• Use additional code for associated conditions


E88.40 Mitochondrial metabolic disorder, unspec

E88.41MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke‐like episodes

E88.49 Other mitochondrial metabolic disorder

Kearns‐Sayre syndrome (KSS) (H49.81*): characterized bychildhood onset of progressive external ophthalmoplegia andpigmentary degeneration of the retina.Cortical blindness (H47.6): the total or partial loss of vision in a normal‐appearing eye caused by damage to the brain's occipital cortex

Metabolic Disorders, more

• Code also myoclonic epilepsy (G40.3*)


E88.42 MERRF syndrome [myoclonus epilepsy with ragged red fibers ]

87

Retained Foreign Body

• Use additional code to identify the type of retained FB (18.*) [wood, glass, metal, plastic]


H02.81* Retained FB lid

H05.5*Retained (old) FB following penetrating wound of unspecified orbit

H44.60* Retained (old) intraocular FB, . . .

Diseases of the Orbit

• Code also associated bone disease


H05.32* Deformity of unspecified orbit due to bone disease

88

Eye Conditions

• Code first (T51‐T65) to identify chemical and intent

• Code also associated Wilson's disease (E83.01)

• Use additional code for any associated cataract (H26.21*)


H18.04* Kayser‐Fleischer ring

H10.21* Acute toxic conjunctivitis

H20.1* Chronic iridocyclitis

Eye Conditions

• Use additional code for adverse effect (T36‐T50) 5th char 5

• Code first underlying condition Excludes cataract in DM

• Code first underlying disease, such as congenital toxoplasmosis (P37.1) histoplasmosis (B39.*)


H21.81 Floppy iris syndromeH26.3* Drug‐induced cataract

H28 Cataract in diseases classified elsewhere

H32 Chorioretinal disorders in diseases classified elsewhere

89

Eye Conditions

• All H35.0 codes: Code also any associated Hypertension (I10.*)

• Code first poisoning; Use additional code for adverse effect.


H35..*** Background retinopathy and retinal vascular changes

H35.38* Toxic maculopathy

Glaucoma, Secondary

• Code also underlying condition [all secondary glaucoma codes]

• Use additional code for adverse effect; identify drug, use 5th or 6th character of 5 [adverse effect]


H40.3** Glaucoma, Secondary to eye trauma . . .H40.4** Glaucoma, Secondary to eye inflammation . . .

H40.6*** Glaucoma, Secondary to drugs . . .

H40.5** Glaucoma, Secondary to other eye disorders . . .

H42 Glaucoma in diseases classified elsewhere

Code first underlying disease

90

Retained FB

• Use additional code to identify the type of retained FB (18.*)

• Wood, metal, glass, plastic

• Use additional code to identify nonmagnetic FB


H44.6** Retained (old) intraocular foreign body, magnetic

H44.7** Retained (old) intraocular foreign body, nonmagnetic

Eye Conditions

• Code first T51‐T65 to identify cause

• Code also underlying condition

• Use additional code for other manifestation, such as heart block (I45.9)


H46.3 Toxic optic neuropathy

H47.4* Disorders of optic chiasm in (due to) other disordersH47.51* Disorders of visual pathways in (due to)

inflammatory disordersH47.6** Disorders of visual cortex

H49.81* Kearns‐Sayre syndrome

91

Alzheimers

• Use additional code to identify type of delirium if applicable.

• F05 Delirium due to known physiological condition


G30.9 Alzheimer's disease, unspecified

Drug‐Induced dyskinesia and dystonia

• Use additional code for adverse effect (T36‐T50) 5th character of 5.

*Adverse effect of antipsychotic medication for long periods.

Dyskinesia are involuntary movements.

Dystonia is a neurological movement disorder.


G24.01 Drug induced subacute dyskinesia*G24.02 Drug induced acute dystoniaG24.09 Other drug induced dystoniaG24.3 Spasmodic torticollis

92

Migraines with auras

• Code also any associated seizure (G40.*; R56.9)


G43.1** Migraine with aura . . .

Migraine, Persistent

• Code also type of cerebral infarction (I63.*)


G43.6** Migraine Persistent aura w/ cerebral infarction

93

Inflammatory Polyarthopathies

• Code also any associated underlying condition such as Crohnsdisease (K50.*) or ulcerative colitis (K51.*)

• Use additional code to identify disorders of iris and ciliary body in diseases classified elsewhere (H22.*)


M08.*** Juvenile arthritis

M1A.**** Chronic goutM10.*** Gout

Summary

• Coding from the manual is always recommended.

• Always follow the second code instructions in ICD‐10.

• Most of these requirements already exist in ICD‐9.

• Start now and audit often.

• If you use a fee ticket, cheat sheet, or lookup program, be sure to follow code also, code first, code additional, and code primary instructions.


94

ICD‐10Coding Additional Required Codes




95

ICD‐10 coding for EyecareComprehensive Coding Training

Sequential Code Review




This is a code‐by‐code review of ICD‐10 codes for Eyecare

• Since an x is now a valid character within ICD‐10 we can no longer use xxx as a wildcard. I will use “*” when there are multiple options.

• Most codes will default to the right eye only in this course.

• While the majority of ICD‐10 codes cross‐walk perfectly, understand that both ICD‐9 and ICD‐10 are international and therefore many ICD‐10 disease descriptions often do not reflect commonly‐used terminology in the United States.


96

Will using an unspecified diagnosis code impact my reimbursement?

• As a certified coder and auditor it is my obligation to instruct everyone on proper and accurate coding rules and guidelines. Submitting all relevant codes to the highest level of specificity is the job of every provider.

• For one, it tells the complete story of the encounter.

• For a patient with a headache, a cluster headache, intractable, is more informative than “headache, NOS”

• Entropion, right upper eyelid, mechanical, is more informative than entropion, unspecified, unknown eye, and unknown eyelid.

• For an injury, adding that the foreign body occurred in their wood shop in their garage on a grinding wheel adds more information when you identify the nature of the encounter.


More on Reimbursement• Converting current unspecific ICD‐9 codes to an unspecific ICD‐

10 fee ticket or cheat sheet is not recommended:

• Some carriers may reject an unspecific Dx.

• It’s always best to get it right the first time than try to fix it later.

• Create good documentation habits: omitting codes and unspecified codes look bad during an audit if the medical document is unspecific.

• Unspecific codes in the documentation or reported suggest “you don’t know what is wrong with the patient.” If you know the specific differential diagnosis but fail to document and report it,that is the same as not knowing.


97

Eyecare H codes (H10‐H16)

1 H00.*** Conditions of the eyelid2 H01.*** Conditions of the eyelid3 H02.*** Entropions4 H04.*** Conditions of the lacrimal system5 H05.*** Conditions of the orbit6 H10.*** Conjunctival conditions7 H15.*** Conditions of the sclera8 H16.*** Keratoconjunctivitis


ICD‐10 starts with the external ocular adnexa.



9 H17.*** Conditions of the cornea10 H18.*** Keratopathies11 H20.*** Conditions of the iris12 H21.*** Disorders of iris and ciliary body13 H25.*** Cataracts14 H26.*** Cataracts, other15 H27.** Conditions of the lens16 H30.** Chorioretinal conditions

Moves to the anterior chamber.

98


17 H31.*** Conditions of the Choroid18 H33.** Conditions of the retina19 H34.*** Retinal occlusions20 H35.*** Retinal changes21 H40.*** Glaucoma22 H43.*** Vitreous codes23 H44.*** Disorders of vitreous body and globe

24 H44.6**Unspecified retained (old) intraocular foreign bodies


Retinal and vitreous conditions.


25 H46.*** Irritations of anterior chamber hypotony26 H47.*** Neuropathies27 H51.*** Convergence disorders28 H52.*** Refraction Disorders29 H53.*** Amblyopia/visual field defects30 H54.*** Blindness31 H55.*** Nystagmus32 H57.*** Pupillary Disorders and ocular pain33 H59.*** Disorders following Surgery


Finishes with neuropathies, refraction disorders, visual field defects, and miscellaneous conditions.

99

ICD‐10 H Code Detail

• We will now go into detail on the specific eye diseases and conditions.

• After the “H” section we will discuss other codes related to Eyecare.

• After we review all the code groups we will discuss actual clinical examples in the afternoon.


H00.***: Conditions of the eyelid

• A hordeolum (stye) is a small infection of the glands in the eye. The codes should be documented and reported by eyelid.

• A chalazion is a cyst in the eyelid that is caused by inflammation of a blocked, oil‐producing meibomian gland.


H00.011 Hordeolum externum right upper eyelidH00.021 Hordeolum internum right upper eyelidH00.031 Abscess of right upper eyelidH00.11 Chalazion right upper eyelid

They are both lumps along the edge of an eyelid. When a styedoes not heal, it can become a chalazion.

100

H01.***: Conditions of the eyelid

• Xeroderma: is dry skin of the eyelid. Do not confuse with xanthelasma, (H02.6*) is a flat, yellowish deposit of fat on the eyelid.

• Note all codes below are listed with right upper eyelid (.**1)


H01.001Unspecified blepharitis unspecified eye, right upper eyelid

H01.011 Ulcerative blepharitis right eye, right upper eyelidH01.111 Allergic dermatitis of right eye, right upper eyelid

H01.121Discoid lupus erythematosus of right eye, right upper eyelid

H01.131 Eczematous dermatitis of right eye, right upper eyelidH01.141 Xeroderma of right eye, right upper eyelid

H01.02*: Conditions of the eyelid

• Squamous blepharitis: a kind of nonulcerative blepharitis in which the edge of the eyelid is covered with small white or gray scales. It may be associated with dandruff.

• It is not cancer and should not be confused with: Squamous cell carcinoma, a cancer of a kind of epithelial cell, the squamous cell; these cells are the main part of the epidermis of the skin.


H01.021 Squamous blepharitis right upper eyelid

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H02.***: Entropions

• Cicatricial entropion: A scar left by the formation of new connective tissue over a healing sore or wound.

• Trichiasis is an ingrown eyelash.

• There is a one‐to‐one ICD‐9 to ICD‐10 crosswalk. However, the

codes are in a different order.


H02.011 Cicatricial entropion of right eye, upper right eyelidH02.021 Mechanical entropion of right eye, upper right eyelidH02.031 Senile entropion of right eye, upper right eyelidH02.041 Spastic entropion of right eye, upper right eyelidH02.051 Trichiasis without entropian right eye, upper right eyelid

H04.***: Conditions of the lacrimal system

• Lacrimal glands are not indicated by punctum as in inferior and superior (eyelid ICD‐10 codes). They are right or left.

• Dacryops: a watery state of the eye. A distention of a lacrimal duct by contained fluid.


H04.021 Chronic dacryoadenitis, right lacrimal glandH04.111 Dacryops of right lacrimal glandH04.121 Dry eye syndrome of right lacrimal glandH04.131 Lacrimal cyst, right lacrimal gland

H04.141 Primary lacrimal gland atrophy, right lacrimal glandH04.151 Secondary lacrimal gland atrophy, right lacrimal glandH04.161 Lacrimal gland dislocation, right lacrimal gland

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H04.201 Unspecified epiphora, right lacrimal gland

H04.211Epiphora due to excess lacrimation, right lacrimal gland (ICD‐9: 375.21)

H04.221Epiphora due to insufficient drainage, right lacrimal gland (ICD‐9: 375.22)

H04.301 Unspecified dacryocystitis of right lacrimal passageH04.311 Phlegmonous dacryocystitis of right lacrimal passageH04.321 Acute dacryocystitis of right lacrimal passageH04.331 Acute lacrimal canaliculitis of right lacrimal passage


• Epiphora is excess tearing.

• Granuloma is a collection of immune cells known as macrophages [on next slide].


H04.411 Chronic dacryocystitis of right lacrimal passageH04.421 Chronic lacrimal canaliculitis of right lacrimal passageH04.431 Chronic lacrimal mucocele of right lacrimal passageH04.511 Dacryolith of right lacrimal passageH04.521 Eversion of right lacrimal punctumH04.531 Neonatal obstruction of right nasolacrimal ductH04.541 Stenosis of right lacrimal canaliculiH04.551 Acquired stenosis of right nasolacrimal ductH04.561 Stenosis of right lacrimal punctumH04.571 Stenosis of right lacrimal sacH04.611 Lacrimal fistula right lacrimal passageH04.811 Granuloma of right lacrimal passage


All are right lacrimal passage. Remember lacrimal is right or left.

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H05.***: Conditions of the orbit

H05.011 Cellulitis of right orbitH05.021 Osteomyelitis of right orbitH05.031 Periostitis of right orbitH05.041 Tenonitis of right orbitH05.111 Granuloma of right orbitH05.121 Orbital myositis, right orbitH05.211 Displacement (lateral) of globe, right eyeH05.221 Edema of right orbitH05.231 Hemorrhage of right orbitH05.241 Constant exophthalmos, right eyeH05.251 Intermittent exophthalmos, right eye


Exophthalmos is a bulging of the eye anteriorly out of the orbit. It is also called proptosis.

H05.***: Conditions of the orbit

H05.261 Pulsating exophthalmos, right eyeH05.311 Atrophy of right orbitH05.321 Deformity of right orbit due to bone disease [Code Also]H05.331 Deformity of right orbit due to trauma or surgeryH05.341 Enlargement of right orbit

H05.351Exostosis of right orbit [rare, a benign outgrowth from a bone]

H05.401 Unspecified enophthalmos, right eye [bulging posteriorly]H05.411 Enophthalmos due to atrophy of orbital tissue, right eyeH05.421 Enophthalmos due to trauma or surgery, right eye

H05.51Retained (old) foreign body following penetrating wound of right orbit

H05.811 Cyst of right orbitH05.821 Myopathy of extraocular muscles, right orbit


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H10.***: Conjunctival conditions


H10.011 Acute follicular conjunctivitis, right eyeH10.021 Other mucopurulent conjunctivitis, right eyeH10.11 Acute atopic conjunctivitis, right eyeH10.211 Acute toxic conjunctivitis, right eyeH10.221 Pseudomembranous conjunctivitis, right eyeH10.231 Serous conjunctivitis, except viral, right eyeH10.31 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.

H10.***: Conjunctival conditions

• Pingueculitis is an inflammed pinguecula [ H11.151].


H10.411 Chronic giant papillary conjunctivitis (GPC), right eyeH10.421 Simple chronic conjunctivitis, right eyeH10.431 Chronic follicular conjunctivitis, right eyeH10.501 Unspecified blepharoconjunctivitis, right eyeH10.511 Ligneous conjunctivitis, right eyeH10.521 Angular blepharoconjunctivitis, right eyeH10.531 Contact blepharoconjunctivitis, right eyeH10.811 Pingueculitis, right eye

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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 eyeH11.011 Amyloid pterygium of right eyeH11.021 Central pterygium of right eyeH11.031 Double pterygium of right eyeH11.041 Peripheral pterygium, stationary, right eyeH11.051 Peripheral pterygium, progressive, right eyeH11.061 Recurrent pterygium of right eye

H11.***: Conditions of the conjunctiva• Pinguecula is a common, non‐cancerous growth of the clear, thin tissue

(conjunctiva) of the eye. It is a yellow‐white deposit on the conjunctiva adjacent to the limbus (the junction between the cornea and sclera).

• Symblepharon is a partial/complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball.


H11.111 Conjunctival deposits, right eyeH11.121 Conjunctival concretions, right eyeH11.131 Conjunctival pigmentations, right eyeH11.141 Conjunctival xerosis, unspecified, right eyeH11.151 Pinguecula, right eye [Note pingueculitis was H10.***]H11.211 Conjunctival adhesions and strands (localized), right eyeH11.221 Conjunctival granuloma, right eyeH11.231 Symblepharon, right eyeH11.241 Scarring of conjunctiva, right eye

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H11.***: Conditions of the conjunctiva

• Conjunctivochalasis: a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eye‐lid margin.


H11.31 Conjunctival hemorrhage, right eyeH11.411 Vascular abnormalities of conjunctiva, right eyeH11.421 Conjunctival edema, right eyeH11.431 Conjunctival hyperemia, right eyeH11.441 Conjunctival cysts, right eyeH11.811 Pseudopterygium of conjunctiva, right eyeH11.821 Conjunctivochalasis, right eye

H15.***: Conditions of the sclera

• These codes crosswalk almost exactly from ICD‐9.


H15.001 Unspecified scleritis, right eyeH15.011 Anterior scleritis, right eyeH15.021 Brawny scleritis, right eyeH15.031 Posterior scleritis, right eyeH15.041 Scleritis with corneal involvement, right eye

Brawny scleritis is a gelatinous‐appearing swelling surrounding, and with a tendency to involve the periphery of the cornea.

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H15.***: Conditions of the sclera

• Scleromalacia perforans, also known as necrotizing scleritis, is the most severe form of scleritis, sometimes leading to loss of the eye. The condition is often associated with systemic disease and involvement of multiple organs. [H15.05*]

• These codes crosswalk almost exactly from ICD‐9.


H15.051Scleromalacia perforans, right eye [does not include the term scleritis in the definition]

H15.091 Other scleritis, right eyeH15.101 Unspecified episcleritis, right eyeH15.111 Episcleritis periodica fugax, right eyeH15.121 Nodular episcleritis, right eye

H16.***: Keratoconjunctivitis

• Kerato means “cornea”.


H16.201 Unspecified keratoconjunctivitis, right eye [Please Avoid]H16.211 Exposure keratoconjunctivitis, right eye

H16.221Keratoconjunctivitis sicca, not specified as Sjogren's, right eye

H16.231 Neurotrophic keratoconjunctivitis, right eyeH16.251 Phlyctenular keratoconjunctivitis, right eye

H16.261Vernal keratoconjunctivitis, with limbar and corneal involvement, right eye

H16.291 Other keratoconjunctivitis, right eye

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KeratitisContact lens‐related keratitis often causes superficial punctatekeratitis (aka punctate erosive keratopathy, punctate epithelial erosions or Thygeson's superficial punctate keratopathy


H16.101 Unspecified superficial keratitis, right eye [370.20]H16.111 Macular keratitis, right eye

H16.121 Filamentary keratitis, right eyeH16.131 Photokeratitis, right eyeH16.141 Punctate keratitis, right eye [370.21]

Keratitis• Interstitial is the space between cells.


H16.301 Unspecified interstitial keratitis, right eye H16.321 Diffuse interstitial keratitis, right eyeH16.331 Sclerosing keratitis, right eyeH16.391 Other interstitial and deep keratitis, right eye

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Keratitis

• In addition to the specific keratitis “H” codes the cause should also be documented and reported. Note these are codes from the “A” and “B” section of the ICD‐10 manual. This is not a complete list.


A18.51 Tuberculous episcleritisA18.52 Tuberculous keratitisA50.31 Late congenital syphilitic interstitial keratitisA54.33 Gonococcal keratitisB00.52 Herpesviral keratitisB01.81 Varicella keratitisB02.33 Zoster keratitisB05.81 Measles keratitis and keratoconjunctivitis

H17.***: Conditions of the cornea

H17.01 Adherent leukoma, right eyeH17.11 Central corneal opacity, right eyeH17.811 Minor opacity of cornea, right eyeH17.821 Peripheral opacity of cornea, right eye


Adherent leukoma/leucoma: a white tumor of the corneaenclosing a prolapsed adherent iris.

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Corneal Scars (H17, H18)

• ICD‐9 Crosswalk is in different order.


ICD‐10 ICD‐9H17.9 371.00 Corneal scars and opacities: corneal opacity,

unspecifiedH17.811 371.01 Corneal scars and opacities: minor opacity of

corneaH17.821 371.02 Corneal scars and opacities: peripheral

opacity of corneaH17.10 371.03 Corneal scars and opacities: central opacity of

corneaH17.01 371.04 Corneal scars and opacities: adherent

leucoma

Phthisical Scars (H17, Q13)

• Phthisis and Phthisical [thahy‐sis] (a wasting away) refers to an eye that has shrunk down due to loss of its fluid. This is an acquired condition that is caused by a disease, trauma or possibly surgery. (Acquired condition would indicate that you had a normal size eye prior to this event.) Also, if the globe is microphthalmic, it would indicate that it is a congenital problem. It never developed to full size.


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Phthisical Scars (H17, Q13)

• ICD‐9 Crosswalk is not one‐to‐one.


ICD‐10 ICD‐9371.05 Corneal scars and opacities: phthisical cornea

[phthisical is not in the ICD‐10]H17.89 Other corneal scars and opacities [use for

phthisical cornea above]H17.10 Central corneal opacity, unspecified eye [Avoid]H17.13 Central corneal opacity, bilateralQ13.3 Congenital corneal opacity [use for Congenital

Form]

H18.***: Keratopathies


H18.001 Unspecified corneal deposit, right eyeH18.011 Anterior corneal pigmentations, right eyeH18.021 Argentous corneal deposits, right eyeH18.031 Corneal deposits in metabolic disorders, right eyeH18.041 Kayser‐Fleischer ring, right eyeH18.051 Posterior corneal pigmentations, right eyeH18.061 Stromal corneal pigmentations, right eye

Argentous: containing univalent silver as argentous chloride or AgCl.

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H18.11 Bullous keratopathy, right eyeH18.211 Corneal edema secondary to contact lens, right eyeH18.221 Idiopathic corneal edema, right eyeH18.231 Secondary corneal edema, right eyeH18.311 Folds and rupture in Bowman's membrane, right eyeH18.321 Folds in Descemet'smembrane, right eyeH18.331 Rupture in Descemet's membrane, right eye

The cornea has five layers (anterior to posterior):1. Epithelium2. Bowman’s layer.3. Stroma4. Descemet membrane5. Endothelium



H18.411 Arcus senilis, right eyeH18.421 Band keratopathy, right eyeH18.441 Keratomalacia, right eyeH18.451 Nodular corneal degeneration, right eyeH18.461 Peripheral corneal degeneration, right eye

Arcus senilis is a white, gray, or blue opaque ring in the corneal margin (peripheral corneal opacity), or white ring in front of the periphery of the iris. Common in the elderly and often a result cholesterol deposits.

Keratomalacia is a softening, drying, or ulceration.

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H18.51Endothelial corneal dystrophy

Fuchs’ endothelial dystrophy (FED) is a degenerative disease of the corneal endothelium with accumulation of focal outgrowths called guttate (drops) and thickening of Descemet’smembrane, leading to corneal edema and loss of vision.



Keratoconus – report stable and unstable

H18.601 Keratoconus, unspecified, right eyeH18.611 Keratoconus, stable, right eyeH18.621 Keratoconus, unstable, right eyeH18.711 Corneal ectasia, right eyeH18.721 Corneal staphyloma, right eye

Keratoconus is an abnormal cone‐shaped protrusion of thecornea of the eye often creating irregular astigmatism.Progressive or nonprogressive? Mild/moderate keratoconus (Amsler stage 1 or 2) and stable corneas.Advanced keratoconus (Amsler stage 3 or 4) and unstable corneas.

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Descemetocele is an ophthalmic condition characterized bythinning of the stroma of the cornea (of the eye) to such extentthat Descemet's membrane is the only layer maintaining theintegrity of the eyeball.

H18.731 Descemetocele, right eyeH18.791 Other corneal deformities, right eyeH18.811 Anesthesia and hypoesthesia of cornea, right eyeH18.821 Corneal disorder due to contact lens, right eyeH18.831 Recurrent erosion of cornea, right eyeH18.891 Other specified disorders of cornea, right eye

H20.***: Conditions of the iris

• Iridocyclitis or Iritis? The term “iritis” is not found in ICD‐10.

• Anterior uveitis includes iridocyclitis and iritis. Iritis is the inflammation of the anterior chamber and iris. Iridocyclitispresents the same symptoms as iritis, but also includes inflammation in the vitreous cavity. This code applies to both.

• Infectious or noninfectious? Report the infection (A or B code).


H20.011 Primary iridocyclitis, right eyeH20.021 Recurrent acute iridocyclitis, right eyeH20.031 Secondary infectious iridocyclitis, right eyeH20.041 Secondary noninfectious iridocyclitis, right eye

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H20.***: Conditions of the iris

• Hypopyon: inflammatory cells in the anterior chamber of eye, seen as yellowish exudate in lower part of anterior chamber of eye.


H20.051 Hypopyon, right eyeH20.11 Chronic iridocyclitis, right eyeH20.21 Lens‐induced iridocyclitis, right eyeH20.811 Fuchs' heterochromic cyclitis, right eyeH20.821 Vogt‐Koyanagi syndrome, right eye

H21.***: Disorders of iris and ciliary body

Hyphema: blood in the front (anterior) chamber of the eye.


H21.01 Hyphema, right eye

H21.1X1Other vascular disorders of iris and ciliary body, right eye [X placeholder code is correct]

H21.211 Degeneration of chamber angle, right eyeH21.221 Degeneration of ciliary body, right eyeH21.231 Degeneration of iris (pigmentary), right eyeH21.241 Degeneration of pupillary margin, right eyeH21.251 Iridoschisis, right eyeH21.261 Iris atrophy (essential) (progressive), right eyeH21.271 Miotic pupillary cyst, right eye

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H21.311 Exudative cysts of iris or anterior chamber, right eye

H21.321Implantation cysts of iris, ciliary body or anterior chamber, right eye

H21.331Parasitic cyst of iris, ciliary body or anterior chamber, right eye

H21.341 Primary cyst of pars plana, right eyeH21.351 Exudative cyst of pars plana, right eyeH21.41 Pupillary membranes, right eye

Hydatid Cysts: describes infection with the larval stage of the cestode (or tapeworm) Echinococcus granulosus. (B67.39: Echinococcus granulosus infection, other)


• Synechiae: an eye condition where the iris adheres to either:

• The cornea: anterior synechia

• The lens: posterior synechia


H21.501 Unspecified adhesions of iris, right eyeH21.511 Anterior synechiae (iris), right eye [to cornea]H21.521 Goniosynechiae, right eyeH21.531 Iridodialysis, right eyeH21.541 Posterior synechiae (iris), right eye [to lens]H21.551 Recession of chamber angle, right eyeH21.561 Pupillary abnormality, right eye

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H25.***: Age Related Cataracts

• The term “senile cataract” is not in ICD‐10; it is listed as age‐related.

• 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 eyeH25.031 Anterior subcapsular polar age‐related cataract, right eyeH25.041 Posterior subcapsular polar age‐related cataract, right eyeH25.091 Other age‐related incipient cataract, right eyeH25.11 Age‐related nuclear cataract, right eyeH25.21 Age‐related cataract, morgagnian type, right eye (ICD‐9 is 366.18)

H25.811 Combined forms of age‐related cataract, right eye [common]

A Whole Lotta Cataract Types

• Mature cataract (total). ICD‐9 366.17 converts to: H25.8*Other age‐related cataract

• Cataract (anterior cortical) (anterior polar) (black) (capsular) (central) (cortical) (hypermature) (immature) (incipient) (mature) 366.9

• senile 366.10• anterior subcapsular polar 366.13• combined forms 366.19• cortical 366.15• hypermature 366.18 converts to morganian type H25.21• immature 366.12• incipient 366.12


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A Whole Lotta Cataract Types

• nuclear 366.16• posterior subcapsular polar 366.14• specified NEC 366.19• subtotal (senile) 366.17• congenital 743.34• total (mature) (senile) 366.17• congenital 743.34• localized 366.21• traumatic 366.22


Still more Cataracts

• black cataract see senile nuclear sclerotic cataract.

• blue cataract, blue dot cataract, blue punctate opacities, scattered throughout the nucleus and cortex of the lens. It is a congenital condition and does not progress or cause a reduction in vision.

• brown cataract, brunescent cataract, see senile nuclear sclerotic cataract. (Brunescent means developing a brownish or amber color over time. Nuclear cataracts are sometimes called brunescent.)


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H26.***: Cataracts, other

• Report the type of cataract codes

• These are Infantile/juvenile, by location


H26.001 Unspecified infantile and juvenile cataract, right eye

H26.011Infantile and juvenile cortical, lamellar, or zonular cataract, right eye

H26.031 Infantile and juvenile nuclear cataract, right eye

H26.041Anterior subcapsular polar infantile and juvenile cataract, right eye

H26.051Posterior subcapsular polar infantile and juvenile cataract, right eye


• Traumatic cataracts occur secondary to blunt or penetrating ocular trauma.


H26.061Combined forms of infantile and juvenile cataract, right eye

H26.101 Unspecified traumatic cataract, right eyeH26.111 Localized traumatic opacities, right eyeH26.121 Partially resolved traumatic cataract, right eyeH26.131 Total traumatic cataract, right eye

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• A secondary cataract occurs from complications after cataract surgery; symptoms include hazy or blurry vision caused by posterior capsule opacity.


H26.31 Drug‐induced cataract, right eyeH26.411 Soemmering's ring, right eyeH26.491 Other secondary cataract, right eye

Glaucoma flecks (also known as glaukomflecken) are spots onthe lens of the eye. Glaucoma flecks may be seen if an acute attack of angle closure has occurred in the past.

Secondary glaucoma

366.31 Cataract secondary to ocular disorders: glaucomatous flecks (subcapsular)

H26.231 Glaucomatous flecks (subcapsular), right eye

366.32 Cataract secondary to ocular disorders: cataract in inflammatory disorders

H26.221 Cataract secondary to ocular disorders (degenerative) (inflammatory) right eye

366.33 Cataract secondary to ocular disorders: cataract with neovascularization

H26.211 Cataract with neovascularization, right eye


Straightforward Crosswalk/Mapping

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H27.**:Conditions of the lens


H27.01 Aphakia, right eye [Absence of a lens]H27.111 Subluxation of lens, right eyeH27.121 Anterior dislocation of lens, right eyeH27.131 Posterior dislocation of lens, right eye

Z96.1 Pseudophakia [artificial lens IOL] [ICD‐9: V43.1]

H30.**: Chorioretinal conditions


H30.001 Unspecified focal chorioretinal inflammation, right eye

H30.011Focal chorioretinal inflammation, juxtapapillary, right eye

H30.021Focal chorioretinal inflammation of posterior pole, right eye

H30.031 Focal chorioretinal inflammation, peripheral, right eye

Focal chorioretinal inflammation [multiple kinds] are defined as a localized inflammation of the choroids and retina which includes: focal chorioretinitis, focal choroiditis, focal retinitis, and focal retinochoroiditis.

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• Always report the specific location.


H30.041Focal chorioretinal inflammation, macular or paramacular, right eye

H30.101Unspecified disseminated chorioretinal inflammation, right eye

H30.111Disseminated chorioretinal inflammation of posterior pole, right eye

H30.121Disseminated chorioretinal inflammation, peripheralright eye

H30.131Disseminated chorioretinal inflammation, generalized, right eye


• Harada's disease, also called Vogt‐Koyanagi‐Harada syndrome, is an acute inflammatory, immune‐system disorder that typically affects bilateral eyes of middle‐aged adults and involves melanocyte‐containing organs such as the skin, ear, meninges, and eye.


H30.141Acute posterior multifocal placoid pigment epitheliopathy, right eye

H30.21 Posterior cyclitis, right eyeH30.811 Harada's disease, right eyeH30.891 Other chorioretinal inflammations, right eyeH30.91 Unspecified chorioretinal inflammation, right eye

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H31.*** : Conditions of the Choroid

H31.001 Unspecified chorioretinal scars, right eye

H31.011Macula scars of posterior pole (postinflammatory) (post‐traumatic), right eye

H31.021 Solar retinopathy, right eyeH31.091 Other chorioretinal scars, right eyeH31.101 Choroidal degeneration, unspecified, right eyeH31.111 Age‐related choroidal atrophy, right eyeH31.121 Diffuse secondary atrophy of choroid, right eye


Solar retinopathy is damage to the eye's retina, particularly the macula, from prolonged exposure to solar radiation or other bright light (arc welders).

H31.*** : Conditions of the Choroid

H31.301 Unspecified choroidal hemorrhage, right eye [Avoid]H31.311 Expulsive choroidal hemorrhage, right eyeH31.321 Choroidal rupture, right eyeH31.401 Unspecified choroidal detachment, right eyeH31.411 Hemorrhagic choroidal detachment, right eyeH31.421 Serous choroidal detachment, right eye


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H33.**: Conditions of the retina• Detachment of the retina.


H33.001Unspecified retinal detachment with retinal break, right eye

H33.011 Retinal detachment with single break, right eyeH33.021 Retinal detachment with multiple breaks, right eyeH33.031 Retinal detachment with giant retinal tear, right eyeH33.041 Retinal detachment with retinal dialysis, right eyeH33.051 Total retinal detachment, right eye

H33.101Unspecified retinoschisis, right eye [abnormal splitting of the retina's neurosensory layers]

H33.111 Cyst of ora serrata, right eyeH33.121 Parasitic cyst of retina, right eye

H33.**: Conditions of the retina

• Detachment and breaks


H33.191 Other retinoschisis and retinal cysts, right eyeH33.21 Serous retinal detachment, right eyeH33.301 Unspecified retinal break, right eyeH33.311 Horseshoe tear of retina without detachment, right eyeH33.321 Round hole, right eyeH33.331 Multiple defects of retina without detachment, right eyeH33.41 Traction detachment of retina, right eye

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H34.***: Retinal occlusions

• These acronyms won’t be in most ICD‐10 lookup databases unless added.


H34.01 Transient retinal artery occlusion, right eye [TRAO]H34.11 Central retinal artery occlusion, right eye [CRAO]H34.211 Partial retinal artery occlusion, right eyeH34.231 Retinal artery branch occlusion, right eye [BRAO]H34.811 Central retinal vein occlusion, right eye [CRAO]H34.821 Venous engorgement, right eyeH34.831 Tributary (branch) retinal vein occlusion, right eyeH34.*** Retinal occlusions

H35.***: Retinal changes

H35.011 Changes in retinal vascular appearance, right eyeH35.021 Exudative retinopathy, right eyeH35.031 Hypertensive retinopathy, right eyeH35.041 Retinal micro‐aneurysms, unspecified, right eyeH35.051 Retinal neovascularization, unspecified, right eyeH35.061 Retinal vasculitis, right eyeH35.071 Retinal telangiectasis, right eye


Retinal telangiectasis: (aka Coats’ disease and exudative retinitis), is a very rare congenital, nonhereditary eye disorder, causing full or partial blindness, characterized by abnormal development of blood vessels behind the retina.

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H35.1**: Retinopathy of prematurity (ROP)

H35.101 Retinopathy of prematurity, unspecified, right eyeH35.111 Retinopathy of prematurity, stage 0, right eyeH35.121 Retinopathy of prematurity, stage 1, right eyeH35.131 Retinopathy of prematurity, stage 2, right eyeH35.141 Retinopathy of prematurity, stage 3, right eyeH35.151 Retinopathy of prematurity, stage 4, right eyeH35.161 Retinopathy of prematurity, stage 5, right eye


A condition affecting prematurely‐born babies due to oxygen therapy.

H35.***: Retinal changesH35.171 Retrolental fibroplasia, right eyeH35.21 Other non‐diabetic proliferative retinopathy, right eyeH35.341 Macular cyst, hole, or pseudohole, right eyeH35.351 Cystoid macular degeneration, right eye

H35.361Drusen (degenerative) of macula, right eye [Drusen associated with dry ARMD]

H35.371 Puckering of macula, right eye [scar tissue]H35.381 Toxic maculopathy, right eyeH35.411 Lattice degeneration of retina, right eye [atrophic]H35.421 Microcystoid degeneration of retina, right eyeH35.431 Paving stone degeneration of retina, right eyeH35.441 Age‐related reticular degeneration of retina, right eyeH35.451 Secondary pigmentary degeneration, right eyeH35.461 Secondary vitreoretinal degeneration, right eye


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H35.***: Retinal changes

H35.61 Retinal hemorrhage, right eyeH35.711 Central serous chorioretinopathy, right eye

H35.721Serous detachment of retinal pigment epithelium, right eye

H35.731Hemorrhagic detachment of retinal pigment epithelium, right eye


ICD‐10 Glaucoma stage codes


H40.1410 Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecifiedH40.1411 Same as above == > mild stageH40.1412 Same as above == > moderate stageH40.1413 Same as above == > severe stageH40.1414 Same as above == > indeterminate stage

Sixth digit is right eye or 1.Seventh digit stage options are 0, 1, 2, 3 and 4.

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Bilateral Glaucoma

• When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not have laterality, that is 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.

• In other words, some glaucoma codes do not have laterality.


H40.0**: Glaucoma

• Glaucoma codes: No stage code required. Codes are in order.


H40.001 Preglaucoma, unspecified, right eye [glaucoma suspect]

H40.011 Open angle with borderline findings, low risk, right eye

H40.021 Open angle with borderline findings, high risk, right eye

H40.031 Anatomical narrow angle, right eye

H40.041 Steroid responder, right eye

H40.051 Ocular hypertension, right eye

H40.061Primary angle closure without glaucoma damage, right eye.

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H40.1*X*: Glaucoma

• Glaucoma codes: Stage code required plus “X” placeholder.


H40.10X* Unspecified open‐angle glaucoma [No laterality]

H40.11X* Primary Open angle Glaucoma (POAG) [No laterality]

Seventh digit stage options are 0, 1, 2, 3 and 4.

H40.***: Glaucoma

• Glaucoma codes: * add a seventh digit to indicate stage.


H40.121* Low‐tension glaucoma, right eye + Stage [20 codes]H40.131* Pigmentary glaucoma, right eye + Stage [20 codes]H40.141* Capsular glaucoma with pseudoexfoliation of lens, right

eye + Stage [20 codes]H40.151 Residual stage of open‐angle glauc, right eye No StageH40.20X* Unspecified primary angle‐closure glaucoma Stage OnlyH40.211 Acute angle‐closure glaucoma, right eye No StageH40.221* Chronic angle‐closure glaucoma, right eye + Stage [20

codes]H40.231 Intermittent angle‐closure glaucoma, right eye, No StageH40.241 Residual stage of angle‐closure glauc, right eye No Stage

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H40.***: Secondary Glaucoma

• Secondary Glaucoma codes: includes laterality, a seventh digit to indicate stage plus the cause of the secondary glaucoma.

• Code underlying disorder.


H40.31X* Glaucoma secondary to eye trauma, right eye [ + ]H40.41X* Glaucoma secondary to eye inflammation, right eye [+]H40.51X* Glaucoma secondary to other eye disorders, right eye [+]H40.61X* Glaucoma secondary to drugs, right eye [+]

H40.811Glaucoma with increased episcleral venous pressure, right eye No Stage

H40.821 Hypersecretion glaucoma, right eye No StageH40.831 Aqueous misdirection, right eye No Stage

Glaucoma Made Easy !

No Stage code, with laterality (sixth‐digit code required)1. H40.0* Glaucoma suspect2. H40.01* Open angle with borderline findings, low

risk3. H40.02* Open angle with borderline findings, high

risk4. H40.03* Anatomical narrow angle5. H40.04* Steroid responder6. H40.05* Ocular hypertension7. H40.06* Primary angle closure without glaucoma

damage


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No Stage code, with laterality (a sixth‐digit code) (4 each)8. H40.15* Residual stage of open‐angle glaucoma9. H40.21* Acute angle‐closure glaucoma10. H40.23* Intermittent angle‐closure glaucoma11. H40.24* Residual stage of angle‐closure glaucoma12. H40.81* Glaucoma with increased episcleral venous

pressure13. H40.82* Hypersecretion glaucoma14. H40.83* Aqueous misdirection



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


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Stage Codes plus laterality (20 codes each!)

1. H40.12** Low‐tension glaucoma

2. H40.13** Pigmentary glaucoma

3. H4014** Capsular glaucoma with pseudoexfoliationof lens

4. H40.22** Chronic angle‐closure glaucoma



Stage Codes plus laterality in the fifth‐digit location, note placeholder 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


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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


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!


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Drance heme?• ICD‐9 to ICD‐10 Crosswalk Program. www.codemap.com

• H35.60 below is Retinal hemorrhage, unspecified eye


362.81 is not considered equivalent to H35.60. What does this mean? It means the zero is an unspecified eye code.

Reverse Lookup

1=right2=left3=bilateral

H43.***: Vitreous codes


H43.01 Vitreous prolapse, right eyeH43.11 Vitreous hemorrhage, right eyeH43.21 Crystalline deposits in vitreous body, right eyeH43.311 Vitreous membranes and strands, right eyeH43.391 Other vitreous opacities, right eyeH43.811 Vitreous degeneration, right eyeH43.821 Vitreomacular adhesion, right eye

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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 eyeH44.011 Panophthalmitis (acute), right eyeH44.021 Vitreous abscess (chronic), right eyeH44.111 Panuveitis, right eye [all parts of the uvea]H44.121 Parasitic endophthalmitis, unspecified, right eyeH44.131 Sympathetic uveitis, right eyeH44.21 Degenerative myopia, right eye

The uvea is exactly where in the eye? This was discussed in theanatomy 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).


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• Chalcosis is a complication due to the toxic effects of copper in the eye.

• Siderosis is a complication due to a magnetic intraocular or intraorbital foreign body.

• Hypotony is low intraocular pressure (5 mm Hg or less)


H44.311 Chalcosis, right eyeH44.321 Siderosis of eye, right eyeH44.391 Other degenerative disorders of globe, right eyeH44.411 Flat anterior chamber hypotony of right eyeH44.421 Hypotony of right eye due to ocular fistula [glaucoma]H44.431 Hypotony of eye due to other ocular disorders, right eye


• Leucocoria / Leukocoria (common spelling is with a “k”. Spelled with a “c” in ICD‐10)


H44.441 Primary hypotony of right eyeH44.511 Absolute glaucoma, right eye [100% nerve damage]H44.521 Atrophy of globe, right eyeH44.531 Leucocoria, right eye

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H44.***: retained (old) intraocular foreign bodies

• Note magnetic and location. These exclude a current FB.


H44.601Unspec. retained (old) intraocular foreign body, magnetic, right eye

H44.611Retained (old) magnetic foreign body in anterior chamber, right eye

H44.621Retained (old) magnetic foreign body in iris or ciliary body, right eye

H44.631 Retained (old) magnetic foreign body in lens, right eye

H44.641Retained (old) magnetic foreign body in posterior wall of globe, right eye

H44.651 Retained (old) magnetic foreign body in vitreous body, right eye

H44.691Retained (old) intraocular foreign body, magnetic, in other or multiple sites, right eye

H44.***: retained (old) intraocular foreign bodies


H44.701Unspecified retained (old) intraocular foreign body, nonmagnetic, right eye [Note nonmagnetic]

H44.711Retained (nonmagnetic) (old) foreign body in anterior chamber, right eye

H44.721Retained (nonmagnetic) (old) foreign body in iris or ciliary body, right eye

H44.731 Retained (nonmagnetic) (old) foreign body in lens, right eye

H44.741Retained (nonmagnetic) (old) foreign body in posterior wall of globe, right eye

H44.751Retained (nonmagnetic) (old) foreign body in vitreous body, right eye

H44.791Retained (old) intraocular foreign body, nonmagnetic, in other or multiple sites, right eye

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H44.***: Luxation of globe

• Hemophthalmos: An effusion of blood into the eyeball. It is an eye hemorrhage.

• Luxation of globe: eye dislocation and eye luxation. It is a common result of head trauma and pressure exerted on the front of the neck. The eyeball pops out of its socket and dangles against your cheek by the thin connective strands of nerve and blood vessel.


H44.811 Hemophthalmos, right eyeH44.821 Luxation of globe, right eye

Vascular problems (H34,H47)

• Lots of acronyms [Remember these earlier?]


H34.01 Transient retinal artery occlusion, right eye TRA ICD-9H47.011 Ischemic optic neuropathy, right eye [H47] AION 377.41H34.11 Central retinal artery occlusion, right eye CRAO 362.31H34.211 Partial retinal artery occlusion, right eye PRAO 362.33H34.231 Retinal artery branch occlusion, right eye RABO 362.32 BAOH34.811 Central retinal vein occlusion, right eye CRVO 362.31 CRAOH34.821 Venous engorgement, right eye 362.37

H34.831 Tributary (branch) retinal vein occlusion, right eye 362.36 BVO

H40.051 Ocular hypertension, right eye

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Optic Conditions H46.***:

• Optic papillitis (intraocular optic neuritis) is a specific type of optic neuritis, is an inflammation of the optic nerve head.

• Retrobulbar neuritis is an inflammation of the part of the optic nerve lying immediately behind the eyeball.


H46.01 Optic papillitis, right eyeH46.11 Retrobulbar neuritis, right eye [MRI required]

Papilledema codes (H47.**)

• Optic disc swelling that is caused by increased intracranial pressure.

• Exception: No laterality. Papilledema most often occur bilaterally.


H47.10 Unspecified papilledema

H47.11Papilledema associated with increased intracranial pressure [neurology consult]

H47.12 Papilledema associated with decreased ocular pressureH47.13 Papilledema associated with retinal disorder

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H47.***: NeuropathiesH47.011 Ischemic optic neuropathy, right eyeH47.021 Hemorrhage in optic nerve sheath, right eyeH47.031 Optic nerve hypoplasia, right eye

H47.091Other disorders of optic nerve, not elsewhere classified, right eye

H47.141 Foster‐Kennedy syndrome, right eyeH47.211 Primary optic atrophy, right eyeH47.231 Glaucomatous optic atrophy, right eye [common]H47.291 Other optic atrophy, right eye


Ischemic optic neuropathy (ION) is the loss of structure and function of a portion of the optic nerve due to obstruction of blood flow to the nerve (i.e. ischemia). ION includes: anterior ischemic optic neuropathy or posterior ischemic optic neuropathy.

H47.***: Neuropathies

H47.311 Coloboma of optic disc, right eye [not congenital code]H47.321 Drusen of optic disc, right eyeH47.331 Pseudopapilledema of optic disc, right eyeH47.391 Other disorders of optic disc, right eye

H47.511Disorders of visual pathways in (due to) inflammatory disorders, right side

H47.521Disorders of visual pathways in (due to) neoplasm, right side

H47.531Disorders of visual pathways in (due to) vascular disorders, right side


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H47.611 Cortical blindness, right side of brain

H47.621Disorders of visual cortex in (due to) inflammatory disorders, right side of brain

H47.631Disorders of visual cortex in (due to) neoplasm, right side of brain

H47.641Disorders of visual cortex in (due to) vascular disorders, right side of brain


Note: the “due to” condition and code the right side or left side of the brain. (Didn’t know we have two brains, did you? It’s one brain but two hemispheres) [these conditions are confirmed by brain imaging].

Right and Left Brain

• Right and left side of the brain. No bilateral brain.


H47.641Disorders of visual cortex in (due to) vascular disorders, right side of brain

H47.642Disorders of visual cortex in (due to) vascular disorders, left side of brain

H47.649Disorders of visual cortex in (due to) vascular disorders, unspecified side of brain

S04.041 Injury of visual cortex, right eyeS04.042 Injury of visual cortex, left eye

S04.049Injury of visual cortex, unspecified eye [you should know]

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H49.01 Third [oculomotor] nerve palsy, right eyeH49.11 Fourth [trochlear] nerve palsy, right eyeH49.21 Sixth [abducent] nerve palsy, right eye

H49.31Total (external) ophthalmoplegia, right eye [eye cannot move]

H49.41 Progressive external ophthalmoplegia, right eyeH49.811 Kearns‐Sayre syndrome, right eyeH49.881 Other paralytic strabismus, right eye


H50.***: tropias and related disorders

• Esotropia is a form of strabismus, (crossed eyes) or "squint", in which one or both eyes turns inward.


H50.011Monocular esotropia, right eye [bilateral more common]

H50.021 Monocular esotropia with A pattern, right eyeH50.031 Monocular esotropia with V pattern, right eye

H50.041Monocular esotropia with other noncomitancies, right eye

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H50.111 Monocular exotropia, right eye [Outward]H50.121 Monocular exotropia with A pattern, right eyeH50.131 Monocular exotropia with V pattern, right eye

H50.141Monocular exotropia with other noncomitancies, right eye

Exotropia is a form of strabismus where the eyes are deviated outward. It is the opposite of esotropia.

Alternating Exotropia

• This is alternating exotropia notmonocular exotropia


H50.15 Alternating exotropia [no laterality]H50.16 Alternating exotropia with A patternH50.17 Alternating exotropia with V patternH50.18 Alternating exotropia with other noncomitancies

H50.21 Vertical strabismus, right eyeH50.311 Intermittentmonocular esotropia, right eyeH50.331 Intermittent monocular exotropia, right eye

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• Cyclotropia: squint in which the eye rolls outward or inward around its front‐to‐back axis.

• Brown’s sheath syndrome (Superior Oblique Tendon Sheath syndrome): a rare form of strabismus characterized by limited elevation of the affected eye.

• Duane’s syndrome: a congenital rare type of strabismus most commonly characterized by the inability of the eye to move outwards.


H50.411 Cyclotropia, right eyeH50.611 Brown's sheath syndrome, right eyeH50.811 Duane's syndrome, right eye

H51.***: Convergence disorders

H51.21 Internuclear ophthalmoplegia, right eye


Internuclear ophthalmoplegia (INO): A disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction.Adduction is toward the middle.Abduction is away from the middle.

The conjugate gaze is the motion of both eyes in the samedirection at the same time.

What does conjugate gaze mean?

145

H52.*** Refraction Disorders

• These were covered in the Introduction Section. Please refer to the slides in that section.


H53.***: Amblyopia/visual field defects

• Amblyopia: This is not a refraction Dx. Many medical plans will pay on this code. Always document the cause.


H53.001 Unspecified amblyopia, right eye [Avoid]H53.011 Deprivation amblyopia, right eye (368.02)H53.021 Refractive amblyopia, right eye (368.03)H53.031 Strabismic amblyopia, right eye (368.01)H53.121 Transient visual loss, right eye (368.12)H53.131 Sudden visual loss, right eye (368.11)H53.141 Visual discomfort, right eye (368.13)

Refractive amblyopia describes a large or unequal amount of refractive error (glasses strength) in a child's eyes.

146

H53.***: Visual field defects

• Hemeralopia: the inability to see clearly in bright light (day blindness.

• Nyctalopia is night blindness.


H53.10Unspecified subjective visual disturbances [Hemeralopia]

H53.19 Psychophysical visual disturbances [Visual halos]H53.2 Diplopia [Double vision]H53.6 Night blindness (nyctalopia)H53.8 Other visual disturbances (blurred vision)H53.9 Unspecified visual disturbance

H54.***: Blindness

• Blindness and low vision (note combinations of blindness, low vision and normal vision). These are not laterality codes !


H54.11 Blindness, right eye, low vision left eyeH54.12 Blindness, left eye, low vision right eyeH54.41 Blindness, right eye, normal vision left eyeH54.42 Blindness, left eye, normal vision right eyeH54.51 Low vision, right eye, normal vision left eyeH54.52 Low vision, left eye, normal vision right eye

These are already in ICD‐9.

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Visual Loss (H54.***)

• Exception: H54.3 reads “both eyes” but is not actually laterality. It is inherently bilateral.


H54.3 Unqualified visual loss, both eyes [not bilateral]

H54.60 Unqualified visual loss, one eye, unspecified

H54.61 Unqualified visual loss, right eye, normal vision left eye

H54.62 Unqualified visual loss, left eye, normal vision right eye

H54.7 Unspecified visual loss [not eye‐specific]


H54.8 Legal blindness, as defined in USA

H55.***: Nystagmus

H55.00 Unspecified nystagmusH55.01 Congenital nystagmusH55.02 Latent nystagmusH55.03 Visual deprivation nystagmusH55.04 Dissociated nystagmusH55.09 Other forms of nystagmusH55.81 Saccadic eye movements [fast movement of an eye]H55.89 Other irregular eye movements


• Nystagmus a condition of involuntary eye movement.

148

H57.***: Pupillary Disorders and ocular pain

• Tonic pupil: (Adie syndrome, Holmes‐Adie Syndrome, or Adie's Tonic Pupil), is a neurological disorder characterized by a slowly and gradually dilated pupil in contrast to normal dilation.


H57.051 Tonic pupil, right eye [Adies Pupil]H57.11 Ocular pain, right eye

H59.*** : Disorders following Surgery


H59.011Keratopathy (bullous aphakic) following cataract surgery, right eye

H59.211Accidental puncture and laceration of right eye and adnexa during an ophthalmic procedure

H59.111Intraoperative hemorrhage and hematoma of right eye and adnexa complicating an ophthalmic procedure

H59.121Intraoperative hemorrhage and hematoma of right eye and adnexa complicating other procedure

149

H59.*** : Disorders following Surgery


H59.221Accidental puncture and laceration of right eye and adnexa during other procedure

These are the last H**. Codes.

H59.311Postprocedural hemorrhage and hematoma of right eye and adnexa following an ophthalmic procedure

H59.321Postprocedural hemorrhage and hematoma of right eye and adnexa following other procedure

Types of Cancer

• Squamous cell carcinoma (SCC or SqCC) is a cancer of a kind of epithelial cell, the squamous cell; these cells are the main part of the epidermis, the outermost layer of the skin.

• Basal cell carcinoma: an epithelial tumor of the skin that seldom metastasizes.

• Melanoma: a cancer of the cells found in the epidermis, called melanocytes. These skin cells make a brown pigment called melanin, which gives the skin its tan or brown color.

• Squamous blepharitis is not a cancer, but a kind of nonulcerative blepharitis.


150

Skin cancers

• Basal cell carcinoma, is the most common, and least dangerous. (500,000 new cases/year) Deaths are rare.

• Squamous cell carcinoma, is common and more dangerous than basal cell (100,000 new cases per year; kills 2,000 per year).

• Melanoma is the least common but most dangerous, with about 32,000 cases per year. About 6,500 die per year from melanoma.


The next three codes are exceptions to Right and Left rule; Right eyelid=2Left eyelid = 9There is no bilateral eyelid for these three codes, just right or left.

C69.** Malignant Neoplasms

C44.102Unspecifiedmalignant neoplasm of skin of right eyelid, including canthus

C44.109Unspecifiedmalignant neoplasm of skin of left eyelid, including canthus

C44.112 Basal cell carcinoma of skin of right eyelid, including canthus

C44.119 Basal cell carcinoma of skin of left eyelid, including canthus

C44.192Other specified malignant neoplasm of skin of right eyelid, including canthus

C44.199Other specified malignant neoplasm of skin of left eyelid, including canthus


151

C69.** Malignant Neoplasms

C43.11 Malignant melanoma of right eyelid, including canthus

C69.81Malignant neoplasm of overlapping sites of right eye and adnexa

C69.91 Malignant neoplasm of unspecified site of right eyeC72.31 Malignant neoplasm of right optic nerve


Additional malignant neoplasm codes. These follow the convention of 1 for the right eye and 2 for the left.

Benign Neoplasm, Eye

• Skin tags are a separate code. (ICD‐9 is 757.39 Other specified anomalies of skin)

• Cutaneous vascular proliferative lesion. [also Q82.5]


D23.11Other benign neoplasm of skin of right eyelid, including canthus

D31.91 Benign neoplasm of unspecified part of right eye

Crosswalk for skin tags links to Q codes, which are listed as congenital conditions.

Q82.5 Congenital non‐neoplastic nevus [skin tags]

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More on Q82.5 (Skin Tags)

• ICD‐10 Q82.5 Manual notes for this code [Includes:]

• Includes: Abnormal palmar creases

• Includes: Accessory skin tags

• Includes: Benign familial pemphigus [Hailey‐Hailey]

• Includes: Congenital poikiloderma

• Includes: Cutis laxa (hyperelastica)

• Includes: Dermatoglyphic anomalies

• Includes: Inherited keratosis palmaris et plantaris

• Includes: Keratosis follicularis [Darier‐White]


Headaches

• Intractable headache means it just won’t go away and is not responding to standard medications and therapies for headaches. The following words are considered synonymous:

• Pharmacoresistant

• Treatment resistant

• Refractory (medically)

• Poorly controlled


153

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.

• Migrainesmay often become transformed into a chronic daily headache by too frequent use of either painkillers or ergots.


Headaches

• R51: Headache [Avoid this code] [excludes tension, migraines, and more specific headache types.]

• Tension headaches are the most common and due to muscle tension and stress.

• 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.

• Patients report the following symptoms: geometric shapes, flashbulbs, jagged lines, heat wavers, sparkling, watery images, and “Swiss cheese” patterns.

• Per ICD‐10, the category G43.*** includes migraine headaches; category G44.*** includes other headaches.


154

Common headaches (without aura)

G43001Migraine without aura, not intractable, with status migrainosus

G43009Migraine without aura, not intractable, without status migrainosus

G43011Migraine without aura, intractable, with status migrainosus

G43019Migraine without aura, intractable, without status migrainosus


Classic headache (with aura)

G43101Migraine with aura, not intractable, with status migrainosus

G43109Migraine with aura, not intractable, without status migrainosus

G43111Migraine with aura, intractable, with status migrainosus

G43119Migraine with aura, intractable, without status migrainosus


155

Headache Codes (G43.**)

• Ophthalmoplegic Migraine is a rare childhood eye disorder, (previously called a “complicated migraine”) that also strikes the nerves that control the eye’s muscles impacting eye movement. [Not the same as an ophthalmic migraine]


G43.B1Ophthalmoplegic migraine, intractable [migraine with difficulty moving eye]

G43.C0Periodic headache syndromes in child or adult, not intractable

G43.C1Periodic headache syndromes in child or adult, intractable

G43.81: Ocular (retinal or ophthalmic) migraine involve a temporary or even permanent loss of vision in one eye.

Headache (G43.C**)

• Note the “C” fourth character. With and without

• Some headache codes have an “A”, “B” or “C” fourth digit character.


G43.C01Periodic headache syndromes in child or adult, not intractable, with status migrainosus

G43.C09Periodic headache syndromes in child or adult, not intractable, without status migrainosus

G43.C11Periodic headache syndromes in child or adult, intractable, with status migrainosus

G43.C19Periodic headache syndromes in child or adult, intractable, without status migrainosus

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Vascular headaches

• G44.1*: Vascular headache is an outdated term and it is no longer a recognized term and not mentioned in the Headache classification of the International Headache society (IHS). However the term is in ICD‐10.


G44.10Vascular headache, not elsewhere classified, not intractable [considered outdated]

G44.11 Vascular headache, not elsewhere classified, intractable

G44.*** Other headache codes

• Headaches


G44.051Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), intractable

G44.059Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable

G44.201 Tension‐type headache, unspecified, intractableG44.209 Tension‐type headache, unspecified, not intractableG44.211 Episodic tension‐type headache, intractableG44.219 Episodic tension‐type headache, not intractableG44.221 Chronic tension‐type headache, intractableG44.229 Chronic tension‐type headache, not intractable

157

G44.*** Other headache codes

• Headaches


G44.001 Cluster headache syndrome, unspecified, intractableG44.009 Cluster headache syndrome, unspecified, not intractableG44.011 Episodic cluster headache, intractableG44.019 Episodic cluster headache, not intractableG44.021 Chronic cluster headache, intractableG44.029 Chronic cluster headache, not intractable

Note: Document and report the type of headaches and whether intractable or not. Please be specific !

G44.*** Other headache codes (more)

• Headaches


G44.301 Post‐traumatic headache, unspecified, intractableG44.309 Post‐traumatic headache, unspecified, not intractableG44.311 Acute post‐traumatic headache, intractableG44.319 Acute post‐traumatic headache, not intractableG44.321 Chronic post‐traumatic headache, intractableG44.329 Chronic post‐traumatic headache, not intractable

G44.40Drug‐induced headache, not elsewhere classified, not intractable

G44.41Drug‐induced headache, not elsewhere classified, intractable

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G44.*** Other headache codes (more)

• Headaches


G44.81Hypnic headache [benign primary headaches that affect the elderly]

G44.82 Headache associated with sexual activityG44.83 Primary cough headacheG44.84 Primary exertional headache [hot weather/high altitude]G44.85 Primary stabbing headacheG44.89 Other headache syndrome

G44.52 New daily persistent headache (NDPH)G44.53 Primary thunderclap headacheG44.59 Other complicated headache syndrome

A thunderclap headache is a headache that is severe and sudden.It typically takes seconds to minutes to reach maximum severity. It can be indicative of a potentially fatal medical problem.

What is background retinopathy?• Aka “BDR” or Background Diabetic Retinopathy.

• A type of damage to the retina of the eye marked by bleeding, fluid accumulation, and abnormal dilation of the blood vessels.

• It is early damage of the retina in diabetes. (aka “early stage” retinopathy)

• Background (diabetic) retinopathy generally means your diabetes is not controlled or if you have been diabetic for 30 years, even with the best control, damage will occur (with type 1).

• There are different types of retinopathy: background retinopathy, maculopathy, and proliferative retinopathy.

• Avoid ICD‐10 code H35.00: Unspecified background retinopathy. This is considered an unspecified code.


159

Diabetic retinopathy has four stages:

1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon‐like swelling in the retina's tiny blood vessels.

2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.

3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment. [all above are background retinopathy]

4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels with thin, fragile walls which can leak blood, and cause severe vision loss and even blindness.


ICD‐9 Other Background Retinopathy362.01 Diabetic retinopathy: background diabetic retinopathy

362.10Other background retinopathy and retinal vascular changes: background retinopathy, unspecified

362.11Other background retinopathy and retinal vascular changes: hypertensive retinopathy

362.12Other background retinopathy and retinal vascular changes: exudative retinopathy

362.13Other background retinopathy and retinal vascular changes: changes in vascular appearance

362.14Other background retinopathy and retinal vascular changes: retinal microaneurysms NOS

362.15Other background retinopathy and retinal vascular changes: retinal telangiectasia

362.16Other background retinopathy and retinal vascular changes: retinal neovascularization NOS

362.17Other background retinopathy and retinal vascular changes: other intraretinalmicrovascular abnormalities

362.18 Other background retinopathy and retinal vascular changes: retinal vasculitis


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ICD‐10 Other Background Retinopathy

E11319Type 2 diabetes w unsp diabetic rtnop w/o macular edema

H3500 Unspecified background retinopathy

H35031 Hypertensive retinopathy, right eye

H35021 Exudative retinopathy, right eye

H35011 Changes in retinal vascular appearance, right eye

H35041 Retinal micro‐aneurysms, right, right eye

H35071 Retinal telangiectasis, right eye

H35051 Retinal neovascularization, unspecified, right eye

H3509Other intraretinal microvascular abnormalities [no laterality]

H35061 Retinal vasculitis, right eye


Diabetes Overview


• Document Type 1 or Type 2; with macular edema or without; with hyperglycemia or hypoglycemia. Other options include:

E1036 Type 1 diabetes mellitus with diabetic cataract

E10649 Type 1 diabetes mellitus with hypoglycemia w/o comaE1065 Type 1 diabetes mellitus with hyperglycemia

E1069 Type 1 diabetes mellitus with other spec complicationE108 Type 1 diabetes mellitus with unspecified complicationsE109 Type 1 diabetes mellitus without complications

E11649 Type 2 diabetes mellitus with hypoglycemia w/o comaE1165 Type 2 diabetes mellitus with hyperglycemia

E1169 Type 2 diabetes mellitus with other spec complicationE119 Type 2 diabetes mellitus without complications

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DM cataract codes (no laterality)

E08.36Diabetes mellitus due to underlying condition with diabetic cataract

E09.36Drug or chemical induced diabetes mellitus with diabetic cataract

E10.36 Type 1 diabetes mellitus with diabetic cataractE11.36 Type 2 diabetes mellitus with diabetic cataractE13.36 Other specified diabetes mellitus with diabetic cataract


ICD‐9 code is 366.41; many more options in ICD‐10

Drug or chemical‐induced DM

E09.311Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema

E09.319Drug or chemical induced DM with unspecified diabetic retinopathy without macular edema

E09.321Drug or chemical induced DM with mild nonproliferative diabetic retinopathy with macular edema

E09.329Drug or chemical induced DM with mild nonproliferative diabetic retinopathy without macular edema

E09.331Drug or chemical induced DM with moderate nonproliferativediabetic retinopathy with macular edema

E09.339Drug or chemical induced DM with moderate nonproliferativediabetic retinopathy without macular edema

E09.341Drug or chemical induced DM with severe nonproliferative diabetic retinopathy with macular edema

E09.349Drug or chemical induced DM with severe nonproliferative diabetic retinopathy without macular edema


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Drug or chemical‐induced DM

E09.351Drug or chemical induced DM with proliferative diabetic retinopathy with macular edema

E09.359Drug or chemical induced DM with proliferative diabetic retinopathy without macular edema

E09.36 Drug or chemical induced DM with diabetic cataract

E09.39Drug or chemical induced DM with other diabetic ophthalmic complication

E09.69 Drug or chemical induced DM with other specified complicationE09.8 Drug or chemical induced DM with unspecified complicationsE09.9 Drug or chemical induced DM without complications


Remember that Type 1 and Type follow the same formatexcept that the first three digits are E10 for Type 1 and E11 forType II.

Drug‐Induced Diabetes


• Drug induced diabetes most often occurs from anti‐hypertensive vasodilator diazoxide, and corticosteroids (prednisone) in high doses such as those used to palliate intracranial tumours.

• Also indicated are Zanosar, an antibiotic and antineoplastic agent used in chemotherapy for pancreatic cancer.

• High doses of thiazide diuretics also can induce diabetes. These selectively destroy pancreatic beta cells resulting in loss of insulin production.

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Q Codes = Congenital Codes

• All congenital [eye] conditions are in a separate section of ICD‐10.


Q12.0 Congenital cataractQ12.1 Congenital displaced lens

Congenital Conditions (more)


Q12.2 Coloboma of lens (not optic disk H47.311)

Colombo: an absence or defect of ocular tissue, due to failure ofpart of the fetal fissure to close; it may affect the choroid,ciliary body, eyelid, iris, lens, optic nerve, or retina.

Q12.3 Congenital aphakiaQ12.4 SpherophakiaQ12.8 Other congenital lens malformationsQ12.9 Congenital lens malformation, unspecified

H59.011Keratopathy (bullous aphakic) following cataract surgery, right eye

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Congenital codes: Eye

• More Congenital codes


Q14.1 Congenital malformation of retinaQ14.2 Congenital malformation of optic disc

Q14.8Other congenital malformations of posterior segment of eye

Q14.9Congenital malformation of posterior segment of eye, unspecified

Q15.8 Other specified congenital malformations of eyeQ15.9 Congenital malformation of eye, unspecified [Peds]

Elevated blood pressure codes• Elevated blood pressure codes. Even though blood pressure is

not a required exam element for Eyecare, it is now required as core measure 4 for meaningful use.


796.2 Elevated blood pressure w/o HTN Dx [ICD‐9 Code]

R03.0Elevated blood‐pressure reading, without diagnosis of hypertension

R03.1 Nonspecific low blood‐pressure reading

Exceptions: Any EP who:Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them.Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure.(Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight.

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Misc. HIV and AIDS codes

• The most common eye manifestation from AIDS are cotton‐wool spots (H35.81) in the retina.


B20: Human immunodeficiency virus [HIV] disease followed by additional diagnosis codes for all reported HIV‐related conditions.Z21: Asymptomatic human immunodeficiency virus [HIV] infection statusR75: Inconclusive laboratory evidence of human immunodeficiency virus [HIV].Z71.7: Human immunodeficiency virus [HIV] counseling.Z16: Resistance to antimicrobial drugs, following the infection code only if the infection code does not identify drug resistance.

R Codes: Signs and Symptoms

• Fever, Headache and Pain Codes


R50.2 Drug‐induced feverR50.81 Fever presenting with conditions classified elsewhereR50.82 Postprocedural feverR50.83 Postvaccination feverR50.84 Febrile nonhemolytic transfusion reactionR50.9 Fever, unspecifiedR52 Pain, unspecified (avoid)

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• Syncope is fainting.


R53.0 Neoplastic (malignant) related fatigueR53.1 WeaknessR53.2 Functional quadriplegiaR53.81 Other malaiseR53.82 Chronic fatigue, unspecifiedR53.83 Other fatigueR54 Age‐related physical debilityR55 Syncope and collapse


• F


R59.0 Localized enlarged lymph nodesR59.1 Generalized enlarged lymph nodesR59.9 Enlarged lymph nodes, unspecified

L04.0 Acute lymphadenitis of face, head and neck

The pre‐auricular lymph nodes are included with the external ocular adnexa per Medicare 1997 Exam Guidelines. External ocular adnexa is a required element for the 920x2 and 920x4 office examinations.

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The ICD‐10 Classification of Mental and Behavioral Disorders (F18/19)

• Dementia and Alzheimer codes


F03 Unspecified dementia

I recommend documenting dementia and/or Alzheimer's in both the ROS (Psychiatric) and the Exam portion (Alert and Oriented X 3) even if the patient is coherent today. These should be documented separately.

G30.0 Alzheimer's disease with early onsetG30.1 Alzheimer's disease with late onsetG30.8 Other Alzheimer's diseaseG30.9 Alzheimer's disease, unspecified

In this instance, the unspecified code would be considered reasonable.

Collagen Vascular diseases

• This includes arthritis and related conditions.

• These fall under the broad category of conditions where an autoimmune reaction causes the body to attack itself. All of these conditions can involve the eye.

• These represent an opportunity to educate your patients, market your clinical services, and cross‐promote with neurologists, orthopedic doctors, endocrine specialists, and primary care providers.


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• M069: Rheumatoid arthritis (unspecified) ) is an autoimmune disease, causes a chronic, systemic inflammatory disorder that principally attacks flexible (synovial) joints.

• M35.0: Sjogren’s syndrome is a systemic autoimmune disease where immune cells attack and destroy the exocrine glands that produce tears and saliva.

• M35.2: Behcet’s disease/syndrome causes inflammation of the blood vessels. It causes a triple‐symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis.



• M02.30: Reiter’s syndrome (reactive arthritis) (ICD‐9: 099.3) is an autoimmune condition that is a secondary response to another infection. Eye conditions associated with this disease include: conjunctivitis, uveitis, red eyes, eye pain, and blurred vision. Other reactive arthropathies (unspecified site) are ICD‐10 code M02.80.

• L40.5/M07: Psoriatic arthritis is an inflammatory arthritis that develops in approximately 30 percent of people who have the chronic skin condition psoriasis. One symptom is iritis.


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• L94.0/L94.1/M34: Scleroderma (aka Systemic sclerosis) is a chronic systemic autoimmune disease of connective tissue and characterized by fibrosis and caused/found with other conditions (6 codes).

• Note the “sclero” refers to hardening and should not be confused with the “sclera” of the eyeball.

• Symptoms include dry eyes, iritis, cataracts and Telangiectasias.



• D86.*: Sarcoidosis (aka sarcoid, Besnier‐Boeck disease or Besnier‐Boeck‐Schaumann disease) is an immune reaction involving abnormal collections of chronic inflammatory cells, most often in the lungs and lymph nodes. Eye involvement includes uveitis, swelling of the lacrimal gland, localized conjunctival swelling, and optic nerve involvement.


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Thyroid conditions:

• In thyroid disease, just as in collagen vascular diseases the body turns on itself. Some of the chemical defenses specifically target the eyes and the result is an inflammatory reaction in the connective tissue of the eyes muscles, fat, and soft tissue. The result is fibrous scarring and fluid swelling.

• Hyperthyroidism, too much thyroid hormone

• Hypothyroidism: too little thyroid hormone

• Thyroid conditions include: Graves’ ophthalmopathy, Graves’ disease, infiltrative ophthalmopathy, endocrine ophthalmopathy, and thyroid eye disease.


Other Diseases

• L71.9: Acne Rosacea (unspecified) can target the eyelids and lead to chronic blepharitis with mild conjunctivitis, as well as acquired telangiectasia.

• G20: Parkinson’s disease causes progressive, involuntary tremors due to a loss of chemical‐producing nerve cells in the brain. One of the symptoms of this condition is decreased blinking and the resultant dry eyes.

• A69.2: Lyme disease is caused by the deer tick, much smaller than the tick seen on pets; the bacteria is Borrelia burgdorferi. Eye involvement includes conjunctivitis and the more serious anterior uveitis. In rare cases the borreliaorganism is localized in the vitreous.


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Other Diseases

• Myasthenia Gravis, an autoimmune disease, is a neuromuscular disorder characterized by intervals of weakness and paralysis. Approximately 90% of patients with this disease develop eye trouble with ptosis and double vision the most common symptoms.

• G70.00: Myasthenia gravis without (acute) exacerbation

• G70.01: Myasthenia gravis with (acute) exacerbation


Cardiology• I61.9: Cerebrovascular accident (CVA) (aka stroke) is rapid

loss of brain function due to disturbance in the blood supply to the brain. Causes include ischemia, blockage, or a hemorrhage. I63.9 is cerebral infarction, unspecified.

• G45.9: Transient Ischemic Attack (TIA) is a due to loss of blood flow to the brain.

• Miscellaneous Codes:


G24.1 Drug‐induced blepharospamG24.5 Blepharospasm [abnormal contraction/twitch of eyelid]

R94.112Abnormal visually evoked potential [VEP] [abnormal study result)

R94.113 Abnormal oculomotor study

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Burn Codes (T26.**)

T26.01X* Burn of right eyelid and periocular areaT26.11X* Burn of cornea and conjunctival sac, right eye

T26.21X*Burn with resulting rupture and destruction of right eyeball

T26.31X* Burns of other specified parts of right eye and adnexaT26.41X* Burn of right eye and adnexa, part unspecified


• 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.

ICD‐9 Superficial Injury Codes

• No specific ICD‐9 to ICD‐10 crosswalk except eyelid.

• The S codes on the next three slides will have the A, D, and S option plus 1 for right eye or eyelid and 2 for left eye or eyelid.


918Superficial injury of eye and adnexa: eyelids and periocular area

918.1 Superficial injury of eye and adnexa: cornea918.2 Superficial injury of eye and adnexa: conjunctiva

918.9Superficial injury of eye and adnexa: other and unspecified superficial injuries of eye

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ICD‐10 Injury and Abrasion Codes

S00.201A Unspecified superficial injury of right eyelid and periocular area, initial encounter [12 codes]

S00.211A Abrasion of right eyelid and periocular area, initial encounter [12 codes]


All are listed with right eyelid and Initial Encounter. No superficial cornea or conjunctiva injury ICD‐10 codes.

S00.221A Blister (nonthermal) of right eyelid and periocular area, initial encounter [12 codes]

S00.241A External constriction of right eyelid and perioculararea, initial encounter [12 codes]

S00.251A Superficial foreign body of right eyelid and perioculararea, initial encounter [ 12 codes]

Chemical accidents• (T51‐T65) to identify chemical and intent for codes T27.4‐T27.7

• Note: There is no laterality for these codes.


T51.*X*T51 codes identify toxic effects of different substances (chemicals) (alcohols)

T52.*X*T52 codes identify toxic effects of different substances (chemicals)

T53.*X* T53 codes identify toxic effects of halogen derivatives (chemicals)Note the Intent Codes below:

T53.0X1 Toxic effect of carbon tetrachloride, accidental (unintentional)

T53.0X2 Toxic effect of carbon tetrachloride, intentional self‐harmT53.0X3 Toxic effect of carbon tetrachloride, assaultT53.0X4 Toxic effect of carbon tetrachloride, undetermined

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Weapons (W Codes)

W34.010 Accidental discharge of airgunW34.011 Accidental discharge of paintball gunW34.110 Accidental malfunction of airgunW34.111 Accidental malfunction of paintball gunX74.02 Intentional self‐harm by paintball gunX95.02 Assault by paintball gun dischargeY24.0 Airgun discharge, undetermined intent

Note: undetermined is a different category (Y) versus intentional (X) [New for ICD‐10]


The W category and term “weapons” is just a coincidence.

W Codes

• These codes indicate the activity that caused the injury.


W27.0 Contact with workbench toolW31.1 Contact with metalworking machines

W31.2Contact with powered woodworking and forming machines

W39 Discharge of firework

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Y Activity Codes

Y93.01 Activity, walking, marching and hikingY93.02 Activity, runningY93.11 Activity, swimmingY93.44 Activity, trampoliningY93.55 Activity, bike ridingY93.62 Activity, American flag or touch football


Eye Injuries – W Codes

• Eye Injuries


W540XXA Bitten by dog, initial encounter

W5501XA Bitten by cat, initial encounter

W5503XA Scratched by cat, initial encounter

W890XXA Exposure to welding light (arc), initial encounter

W891XXA Exposure to tanning bed, initial encounter

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More W Codes

AccidentW27.1 Contact with garden toolW29.2 Contact with other powered household machinery

W29.3Contact with powered garden and outdoor hand tools and machinery


Y29XXXA Contact with blunt object, undetermined intent, initial encounter

And a Y code for contact with a blunt object.

Private Residence (injury location)

Y92.000Kitchen of unspecified non‐institutional (private) residence as the place of occurrence of the external cause

Y92.001Dining room of unspecified non‐institutional (private) residence as the place of occurrence of the external cause

Y92.002

Bathroom of unspecified non‐institutional private) residence single‐family (private) house as the place of occurrence of the external cause

Y92.003Bedroom of unspecified non‐institutional (private) residence as the place of occurrence of the external cause

Y92.007Garden or yard of unspecified non‐institutional (private) residence as the place of occurrence of the external cause

Y92.008Other place in unspecified non‐institutional (private) residence as the place of occurrence of the external cause

Y92.009Unspecified place in unspecified non‐institutional (private) residence as the place of occurrence of the external cause


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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 causeY92.830 Public park as the place of occurrence of the external

cause

Z Codes

Z03.89Encounter for observation for other suspected diseases and conditions ruled out

Z04.2Encounter for examination and observation following work accident

Z56.3 Stressful work schedule* [for entertainment purposes only]

Z56.4 Discord with boss and workmates* [See above]

Z56.5 Uncongenial work environment

Z56.6 Other physical and mental strain related to work


• Additional information explaining the condition.

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Long‐Term use of High Risk Drug codes



Z79.01Long term (current) use of anticoagulants [blood thinner]

Z79.02Long term (current) use of antithrombotics/antiplatelets

Z79.1Long term (current) use of non‐steroidal anti‐inflammatories (NSAID)

Z79.2 Long term (current) use of antibioticsZ79.3 Long term (current) use of hormonal contraceptivesZ79.4 Long term (current) use of insulinZ79.51 Long term (current) use of inhaled steroidsZ79.52 Long term (current) use of systemic steroids


• Use Z79.899 for screening for Plaquenil use.


Z79.810Long term (current) use of selective estrogen receptor modulators (SERMs)

Z79.811 Long term (current) use of aromatase inhibitors

Z79.818Long term (current) use of other agents affecting estrogen receptors and estrogen levels

Z79.82 Long term (current) use of aspirinZ79.890 Hormone replacement therapy (postmenopausal)Z79.891 Long term (current) use of opiate analgesic

Z79.899 Other long term (current) drug therapy [Plaquenil]

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Z codes: Factors influencing health status and contact with health service

• These were V codes in ICD‐9.


Z18.10 Retained metal fragments, unspecifiedZ18.11 Retained magnetic metal fragmentsZ18.12 Retained nonmagnetic metal fragmentsZ18.2 Retained plastic fragments

Z18.33 Retained wood fragmentsZ18.39 Other retained organic fragmentsZ18.81 Retained glass fragmentsZ18.83 Retained stone or crystalline fragmentsZ18.89 Other specified retained foreign body fragmentsZ18.9 Retained foreign body fragments, unspecified material

Family History Codes (Z83.**)Z65.2 Malingerer [person feigning illness [V65.2]


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 glaucomaZ83.518 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


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ICD‐10 for Eyecare

• In summary that’s a lot of ICD‐10 codes!

• However we did not include every code you will every use.

• Optimally, the providers should document every encounter to the highest level of specificity.

• A coder should then translate the notes into accurate ICD‐10 codes.

• In the next section we will discuss some specific, case studies.


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ICD‐10 Coding for EyecareOphthalmology/Optometry Documentation Scenarios




Documentation Components

• In the following cases, we will also review proper documentation of CC, HPI, ROS, and PMH.

• CC: Chief Complaint.• Presenting Problem: E & M Concept. Why is the patient

here?• HPI: History of Present Illness• ROS: Review of Systems• PMH. Past Medical History (Part of the Past, Family and

Social History [PFSH] portion of History)• MDM: Medical Decision Making (part of three key

components of an Evaluation and Management (E & M) encounter.


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Right Eye Pain Scenario

• CC/HPI: A 51 year‐old African American female presents with a sudden onset of right eye pain, severe headache, blurred vision, nausea, and vomiting.

• The HPI, above includes where, timing, quality and associated signs and symptoms.

• It is not clear if the pain was sudden (timing) or if it just happened (duration). These are separate and distinct and must be clear. Was it a “sudden onset within the last hour,” or “three hours ago?”


Right Eye Pain

H57.11 Right eye pain [Note *1 for Right Eye]Severe headache, [ Use the word "intractable“; severe headache is not in ICD‐10]

G44.201 headache, tension, intractableG44.209 headache, tension, not intractable


R11.0 NauseaR11.10 Vomiting, unspecifiedR11.11 Nausea w/ vomiting; Use the Combination Code

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Right Eye Pain


The patient also reports seeing rainbow colored halos around lights. These symptoms began 2 hours ago without any inciting event.

The patient was watching television when the symptoms began.

There is no history of trauma, flashing lights, curtains, metamorphopsia or diplopia.

• More documentation:

Red, Itchy Eyes Scenario

H40.21* Dx: Acute angle closure glaucoma [list which eye]CC: “red, itchy eyes” [HPI: Add duration]

Dx: acute mucopurulent conjunctivitis of both eyes.

Symptoms comprise of an injected, painful eye [does not state which one], tenderness to palpation, vision loss/blurred vision, photophobia, corneal opacity, non‐reactive pupil, severe headache with nausea, severe profusely purulent exudate, poor extraocularmovement, and ciliary flush (ring of red or purple around the cornea).


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Red, Itchy Eyes

H57.13 Injected, Painful Eye [bilateral]x Tenderness to Palpation

H53.8 368.8 Blurred vision [provider combined blurred vision and vision loss]

H54.3 Vision Loss [Three types: transient, sudden and unqualified] unqualified, both eyes [See expanded version of this code.]

H53.143 368.13 visual discomfort; Subjective visual disturbances: [Photophobia] [bilateral]

H17.13 Corneal Opacity [central] [bilateral]

H21.563 Non‐Reactive Pupil [pupillary abnormality] [bilateral]


Red, Itchy Eyes

x Severe Profusely Purulent ExudateH05.823 Myopathy of extraocular muscles, bilateral orbit

[Poor Extraocular Movement ]H21.89 364.89 Ciliary Flush [Ring of red or purple around the

cornea]H57.9 379.93 Red eyes [Unspecified disorder of eye and adnexa; no

laterality]


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Left Eye Pain and Blurry Vision Scenario

• CC: “left eye pain and blurry vision”

• Superficial, Traumatic Corneal Abrasion. Foreign‐Body Sensation, Excessive Tearing


H53.8 Blurry Vision

x Foreign‐Body SensationH04.202 Excessive Tearing (epiphora) unspecified as to cause

[left lacrimal gland]H04.212 Epiphora is due to excess lacrimation or insufficient

drainage, left lacrimal gland.

Z96.1 Pseudophakia [is now a Z code]

Decreased Vision Scenario

• CC/HPI: A 72 year old woman presents with decreased vision in her right eye over the past several months. She states that images appear distorted when viewed with her right eye (monocular metamorphopsia).

• For example, when she looks at the fence in her backyard it appears curved.

• Also, when she’s reading it appears as though parts of the letters are missing.

• Her vision seems to be getting worse with time. She denies any changes in her left eye and has never experienced anything like this before. The only time her vision improves is when she closes her right eye. She denies any history of trauma.

• Possible diagnoses include the following:


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Decreased Vision Scenario

H35.37 1. Macular pucker (epiretinal membrane) with a pseudohole.H59.031 2. Cystoid macular edema [right eye] [CME]H35.341 3. Lamellar macular hole. [Macular cyst, hole, or pseudohole,

right eye]

H35.304. Age‐related macular degeneration [this is unacceptable documentation ‐‐ is it wet or dry?] unspecified

H35.711 5. Central serous retinopathy. [Central serous chorioretinopathy, right eye]


Crossed Eyes with an infant scenario

• CC: “crossed eyes”

• A 6 month old female infant presents with occasional crossing of her eyes. Her parents believe that her left eye deviates nasally more than the right. The infant responds to light, tracks faces, and plays with toys without issue. [Indicate duration]

• Dx: infantile esotropia and amblyopia of the left eye. [There is no infantile or congenital esotropia in ICD‐10].


187

Crossed Eyes (causes)

H52.31 Anisometropia (Differential In Refraction Between Eyes)H50.9 Strabismus (Misaligned Eyes) [Avoid unspec. Strabismus H50.9]

[Other paralytic, unspec. Paralytic, vertical, mechanicalneed additional documentation ]


H50.00 378.00 Esotropia, unspecified [no infantile]H53.002 amblyopia of the left eye. [ This is unspecific;

four kinds: unspec., deprivation, refractive, strabismic]

Burning pain in Eye Scenario

• CC: Burning pain in left eye [be more specific; is it cornea or eyelid? Both?]

• Chemical burns [this is unspecific. What kind? When did it happen? Where did it happen?]

• [Document if chemical burn is alkali, acidic or neutral.] [.1 = organic compound; .2 = acid; .3 = alkalis]

• Note use of the ”X” placeholder code.


188

Burning pain in Eye

T54.3X1*Toxic effect of corrosive alkalis and alkali‐like substances, accidental (unintentional)

T54.3X2*Toxic effect of corrosive alkalis and alkali‐like substances, intentional self‐harm

T54.3X3*Toxic effect of corrosive alkalis and alkali‐like substances, assault

T54.3X4*Toxic effect of corrosive alkalis and alkali‐like substances, undetermined [ Avoid if possible]


The * indicates the occurrence code: either “A” for initial; “D” for subsequent or “S” for sequela. Be sure to add Y92.63: Factory as the place of occurrence of the external cause.

Annual Check‐Up Scenario• CC: Yearly check‐up [Do not document this Chief Complaint as a

“yearly check‐up. “• First issue is “a check up for what?” If this patient has no diseases

or conditions, then it is reported with the ICD‐10 Z codes for routine eye exam. However, this encounter is a screening for a high‐risk patient with diabetes, hypertension, and obesity. That is how the CC should be documented. Linking a 920xxx or 99xxx to a diabetes code should be reimbursed under medical insurance.]

• HPI: A 45 year‐old male with hx of DM Type 2 x 15 years and hypercholesterolemia presents to the Eye Clinic for his annual visit. He states that he has noticed some progressive blurring of vision since his last visit one year ago. Reading street signs while driving seems more difficult. He is unsure of which eye seems worse. He does not wear any glasses or contacts with the exception of over‐the counter reading glasses. He denies any flashes or floaters, any eye discomfort, or any recent eye pain.

• PMHx: Hypercholesterolemia, Obesity, DM Type 2, Hypertension


189

Annual Check‐Up (for Diabetes)

• E11.9 DM Type 2, without complications

• [document with or without hypoglycemia]

• Hypertension [essential] [I10]

Link the visit to the DM Type 2


E78.0 Pure hypercholesterolemiaZ13.21 Encounter for screening for nutritional disorder

Annual refraction appointment scenario

• CC: Annual refraction appointment. [reimbursable only through a Vision Plan or a Medical Plan with a refraction“rider.”]

• HPI: 43 yo Female w/ ocular history which includes only mild myopia, presents for annual refraction exam.

• [Note: every patient should be asked at least five questions when scheduling the appointment (see next slide); You should not have a CC of “refraction appointment” documented and then report a medical encounter if a concern or condition was known beforehand.]


190

Pre‐scheduling questions for annual check‐up/refraction encounters

• Do you have blurry vision?

• Do you have flashers/floaters?

• Do you have any eye pain, dry eyes, double vision, excessive tearing, or headaches?

• Do you have any chronic conditions like diabetes, hypertension or a thyroid condition (list those that could affect their eyes).

• Do you have an asymptomatic condition like glaucoma?

• Do you have any difficulty reading, watching TV, driving, driving at night or leisure activities like golf or knitting?


Refraction appointment becomes a Medical Encounter

• HPI continued: Upon questioning, patient states she has been experiencing dry eyes and mild ocular irritation. In addition, family members have told her that her eyes "look different." She denies double vision.

• This patient presents with Grave’s ophthalmopathy. Grave's ophthalmopathy occurs secondary to an autoimmune process which leads to extraocular muscle inflammation and orbital congestion.


191

Grave’s ophthalmopathy

• Note the lack of specificity in the documentation below. Most all of it is not “ICD‐10 compliant or ready.”

• Upper And Lower Eyelid Retraction [Cannot assume it is bilateral; Document specifically for ICD‐10.]

• Dry Eyes [document which lacrimal gland for ICD‐10]

• Muscle weakness [vague

• Double Vision [this is diplopia and acceptable]

• Excessive tearing [Unspecified; bilateral] [Excessive tearing] [which lacrimal gland? due to what? Excess lacrimation or insufficient drainage?]

• Eye Irritation [No irritation term in ICD‐10; use eye pain]


Parting Notes

• I recommend reviewing this presentation at least twice; once in 2014 and then again at least 3 months before October 1 2015.

• Documentation should be audited and updated in 2014. This should be done once a month the three months before Oct 1 2015.

• When you get your ICD‐10 books, be sure to review them carefully and take notes.

• Highlight all codes that require a second code (Code additional, Code first and Code underlying cause…)

• Highlight all Includes and Exclude diseases relevant to your practice.


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Summary (1 of 2)

• No computerized crosswalk or GEM program will be 100% accurate converting ICD‐9 codes to ICD‐10 codes. For many codes there is no direct crosswalk. For others, the ICD‐9 descriptions are no longer in ICD‐10.

• Significant analysis and review of numerous codes will be necessary. There will always be debate as the new ICD‐10 are used by clinicians, coders and billers. The best source will be Medicare and the private carriers as they publish information.


Summary (2 of 2)

• The World Health Organization (WHO), American Hospital Association (AHA), American Hospital Information Management Association (AHIMA), and Medicare will all provide input concerning the proper use of ICD‐10 codes. In addition, private insurance companies and Medicaid (by state) can and will add their requirements concerning which ICD‐10 codes should be reported based on clinical documentation and medical necessity guidelines.

• This will be an evolving process and no one should assume that ICD‐10 code selection and usage is static, unalterable, and set in stone. Once we learn proper coding and the basics the real challenge of getting paid begins.


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Thank you for Joining us for ICD‐10 coding for EyecareOphthalmology/Optometry.

My contact information is below if you have specific questions. We have a complete recorded coding and billing course (six hours) plus over 24 recorded webinars. Be sure to visit the EyeCodingForum.com website often.

Jeffrey Restuccio, CPC, CPC‐H, MBA

Memphis TN

(901) 517‐1705

[email protected]

www.EyeCodingForum.com


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Cross Country Education complies with all rules and regulations set forth by the boards/associations to offer continuing education. It is imperative that you complete your evaluation so that proper reporting can be done.

Instructions for Completing your Scan Evaluation Form

1. Use a No. 2 pencil or a blue or black ink pen only.2. DO NOT bend or fold your Scan Evaluation Form.3. Please make solid marks that fill the response completely without any stray

marks.4. Complete your first and last name in ALL CAPS (if you do not have enough

space for you full name, simply use all boxes that are available.)5. Write in your registration number in the appropriate box.6. Mark your profession.7. Fill in license number.8. Clearly mark all boxes appropriately.9. Complete the back page of the evaluation; your Seminar Evaluation

Objectives are on the following page for you.10. Return your completed Scan Evaluation form back to the instructor.

Seminar Evaluation Objectives ICD-10 for Optometry and Ophthalmology Speaker: JEFFREY RESTUCCIO, CPC, CPC-H, MBA The purpose/goal of this activity is for participants prepare for ICD-10 by preparing and implementing a training program, reworking fee tickets, updating practice management software, establishing documentation policies, and an internal audit system to ensure accuracy, compliance, and maximum reimbursement. Objectives:

1. Summarize the ICD-10 for Eyecare and its similarities/differences to the ICD-9?

2. Review top Eyecare conditions such as glaucoma, cataracts, DES, ARMD, and retinal conditions and injuries?

3. Examine eyelid codes?

4. Prepare your practice to integrate the new codes into the LCD’s and medical necessity

requirements of carriers?

5. Discover top peripheral codes applicable to Eyecare?

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ICD-10 for Optometry & Ophthalmology- On-Demand Presented by Jeffrey Restuccio

TEST

1. In an outpatient setting, how do you code for a “rule-out” of a blow-out fracture?

a. You cannot; you can only report the signs and symptoms b. Just use the orbit fracture code c. There is no ICD-10 code for a “blow out” fracture d. Code S02.3xxa

2. The five layers of the cornea are Epithelium, Bowman’s layer, Stroma, dura mater, and

endothelium. a. True b. False

3. The total number of ICD-10 digits is 6.

a. True b. False

4. H codes are eye disease codes.

a. True b. False

5. What three things should every clinic do in preparation for ICD-10?

a. Memorize as many ICD-10 codes as possible b. Once a month, code both ICD-9 and ICD-10 codes c. Buy an ICD-10 manual as soon as possible and code from it d. Circle unspecific codes, generate a list of all ICD-9 codes reported, and audit

documentation

6. Is ICD-10 required for all carriers? a. Non-HIPAA covered intities such as workers comp, nursing homes, and home health

agencies, technically do not have to accept ICD-10 codes b. Yes c. Any carrier can opt out d. Only state Medicaid’s are exempt

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7. How many total digits/codes are possible from eyelid diagnoses, like dermatochalasis? a. 4 b. 6 c. 7 d. 9

8. What digits represent right, left, bilateral, and unspecified eyes, respectively?

a. E1, E2, E3, E4 b. 1, 2, 3 and 9 c. 0, 1, 2, and 3 d. RT, LT, 51, and no modifier

9. What does the “X” and last 1 mean in the following code: H40.11X1?

a. Placeholder, right eye b. Wild card for eye, stage code c. Wildcard for stage, right eye d. Placeholder, stage code

10. Senile cataracts are reported in ICD-10 as age-related.

a. True b. False

11. A and B codes are for viral and bacterial infections.

a. True b. False

12. There is no time limit on a “late effect” codes.

a. True b. False

13. How are glaucoma stage codes reported in ICD-10?

a. They are reported separately with the primary glaucoma code b. They are reported in the glaucoma code as a seventh digit option with 0, 1, 2, 3, and 4 c. They are reported in the glaucoma code as a seventh digit option with 1, 2, 3, 4, and 9 d. Stage codes are no longer reported

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14. Glaucoma codes now: a. Include the stage code (combination code) b. All have an “X” placeholder code c. Are all 7 digits d. Include 3 new types of glaucoma

15. H52 codes are refraction codes.

a. True b. False

16. ARMD codes have laterality.

a. True b. False

17. In ICD-9 after-cataract codes, not obscuring vision, and obscuring vision:

a. Crosswalk with the same specificity that currently exists in ICD-9. b. Crosswalk to codes H26.48* and H26.49* c. Have expanded to four codes d. Are now just one unspecific code (H26.491)

18. Diabetes 1 and 2, without complications, are respectively E10.65.

a. True b. False

19. Diabetes with hyperglycemia means:

a. Background retinopathy b. The same as uncontrolled in ICD-9 c. The patient in NIDDM d. They have an ophthalmic manifestation

20. An Includes 2 code can be reported with the primary code with proper documentation.

a. True b. False

21. ICD-10 codes for pterygium do not include:

a. Nasal and temporal b. Central c. Peripheral d. Recurrent

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22. Modifier 24 : a. Is used for an unrelated service during the port-op period of a major surgery b. Is reported when an E & M office visit and small procedure are performed on the

same day of service. c. Is for increased surgical procedures d. Is for a reduced procedure

23. On the claim form, punctual plug insertion modifiers E1-E4 must be matched up with a. Individial eyelid codes in ICD-10 b. Nothing; there is no laterality to DES codes c. The right or left lacrimal system codes d. Assign to the bilateral eyelid code

24. For the conditions in diseases classified elsewhere (e.g., cataracts) code first the

underlying condition. a. True b. False

25. For “toxic” conditions code first the chemical and intent (T codes). a. True b. False

26. For secondary glaucoma: a. Code also the underlying condition b. These codes are now H42 codes c. Only code the stage; there is no laterality d. Be sure to include the “X” placeholder code

27. Is degenerative myopia a medical or a refractive disorder? a. Refractive b. Refractive but paid by medical insurance c. Medical but not paid on by medical insurance d. Medical and paid by medical insurance

28. Brawny scleritis is a gelatinous-appearing swelling surrounding, and with a tendency to involve the periphery of the cornea. a. True b. False

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29. H40 codes are: a. Refraction codes b. Cataract codes c. Glaucoma codes d. Surgical misadventure codes

30. Squamous blepharitis is a kind of nonulcerative blepharitis in which the edge of the eyelid is covered with small white or gray scales. It may be associated with dandruff. a. True b. False

31. Punctate keratits, right eye [370.21] is ICD-10 code: a. H16.141 b. H16.142 c. H16. 143 d. H16.151

32. Tear film insufficiency, code 375.15 becomes H04.121, Tear film insufficiency in ICD-10. a. True b. False

33. Exophthalmos: a. is a bulging of the eye posteriorly out of the orbit. It is also called proptosis. b. is a bulging of the eye anteriorly out of the orbit. It is also called diplopia. c. is a bluging of the eye anteriorly out of the orbit. It is also called proptosis. d. is a bulging of the eye anteriorly out of the orbit. It is also called hypotony.

34. For keratitis conditions report the type and the infectious agent. a. True b. False

35. 2 codes are related to descemet membrane. a. True b. False

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36. The three types of amblyopia in ICD-10 are: a. Deprivation, refractive, and strabismic b. Mechanical, cicatricial, refractive c. Degenerative, refractive, and strabismic d. Degenerative, refractive, and idiopathic

37. Hemeralopia is night blindness code: H53-10.

a. True b. False

38. A choroidal nevus, 224.6 is a. D31.31, a benign neoplasm b. D31.31, a malignant neoplasm c. D31.30, a benign neoplasm d. D31.32, a benign neoplasm

39. An intractable headache: a. Is a severe headache b. Is one that just won’t quit and is pharmaco-resistent c. Is considered idiopathic d. Lasts longer than 72 hours

40. G codes are used for headaches and neurological conditions like blepharaspasm. a. True b. False

41. The presenter recommend that dementia and Alzheimer’s be documented. a. True b. False

42. Tension Headache codes, G43.0** have flags for aura, intractability, and status migrainosus. a. True b. False

43. Sarcoidosis (D86*) is an immune reaction involving abnormal collections of chronic inflammatory cells, most often in the lungs and lymph nodes. Eye involvement includes uveitis, swelling of the lacrimal gland, localized conjunctival swelling. a. True b. False

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44. Background retinopathy includes:

a. Mild, moderate, and unknown b. Mild, moderate, severe, and proliferative c. Idiopathic retinopathy d. Mild, moderate, and severe retinopathy

45. ICD-10 code E09.3 ** a. Is a Diabetes Type 1 b. Is a Diabetes Type 2 c. Is drug or chemical-induced Diabetes d. Is other specified diabetes

46. Q codes are a. Neurological codes b. Are congenital condition codes c. Cataract codes d. For signs and symptoms

47. ICD-9 codes E931.4 and ICD-10 code T37.2X5A are reported for adverse effect of plaquenil. a. True b. False

48. Code Z21 is the HIV code. a. True b. False

49. The instructor recommended four codes for location: home, school, factory, amusement park. a. True b. False

50. Y and W codes are a. Neurological codes b. Congenital condition codes c. Cataract codes d. Activity and locations

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