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Conquering ICD-10-CM — Frequently Asked Questions


Question Answer
Let's say someone has blepharitis squamous upper and lower lids OU. How do I specify location with the ICD-10 code H01.02-? I understand that 1 and 2 mean right upper and lower lids, respectively, and 4 and 5 mean left upper and lower lids, respectively, but what do I use for OU both upper and lower lids? Surely I am not going to use four codes for blepharitis OU, right? While not every condition has a reportable code for each lid, squamous blepharitis does. Correct reporting will be:

H01.021 right upper
H01.022 right lower
H01.024 left upper
H01.025 left lower

It is still to be determined if reporting all four is required for payment.
Since ICD-10-CM has more codes, is it more difficult to use than ICD-9-CM? No.  As stated in a recent ICD-10 Basics webinar hosted by CMS, Just as the size of a dictionary or phone book doesn’t make it more difficult to use, a higher number of codes doesn’t necessarily increase the complexity of the coding system – in fact, it makes it easier to find the right code. Greater specificity and clinical accuracy make ICD-10-CM easier to use than ICD-9-CM.  Because ICD-10-CM is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9-CM.  The Alphabetic Index and electronic coding tools will continue to facilitate proper code selection.
Is there any way to be exempt from ICD-10? No.  Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition. Not just those who submit Medicare or Medicaid claims.
Will there be a transition time when both ICD-9 and ICD-10 will have to run concurrently? On Sept. 30, 2015 ICD-9 will be closed and on Oct. 1, 2015 claims should be submitted with ICD-10 codes. However both systems will have to be utilized until all outstanding or appealed claims have been resolved.

NOTE: Third Party Liability Insurance is not required to change. Therefore, you may still need to use ICD-9.
What is different about the new CMS 1500 form version 02/12? The main difference is there is room to add 12 diagnosis codes to accommodate ICD-10 in box 21. Be sure to indicate in the top right hand corner of this box in the field labeled “ICD Ind.” which code set you are using; ICD-9 or ICD-10.

Click here for instructions on how to fill out this form.
I use a billing company. Will that make a difference? Billing companies will have to follow implementation steps just as physician practices will have to do. Their staff will have to be trained as well.
Will CPT and/or HCPCS codes still exist? Yes.  ICD-10-CM does not impact CPT and or HCPCS codes.
I am working on a "cheat sheet" for our billers when I came across the codes for POAG. I am a little confused as to how to code a patient that has POAG. Is it H40.11X and the appropriate stage coding? I noticed there are not any eye indicators? You are correct. There are no eye indicators.

H40.11 Primary open-angle glaucoma Chronic simple glaucoma

One of the following 7th characters is to be assigned to code

H40.11 to designate the stage of glaucoma
0 – stage unspecified
1 – mild stage
2 – moderate stage
3 – severe stage
4 – indeterminate stage
Is there a way to differentiate between old and recent retinal detachment in ICD-10? CMS and NCVHS has made no such differentiation in the ICD-10-CM at this time.