Making an ICD-10 Superbill—A Practice Converts Its 20 Most-Used ICD-9 Codes

Correction: The codes for Vitreomacular adhesion (vitreomacular traction) are H43.391, H43.392, and H43.393. Due to an editing error, the original version of this article incorrectly listed them as H43.911, H43.912, and H43.913.

Have you developed your paper superbill for ICD-10 yet? If not, you need to get busy—the Oct. 1 transition to ICD-10 is drawing near. Your first step is to decide which approach you want to take. Your options include the following:

• Convert your existing superbill. Many practices have been taking the ICD-9 codes on their existing superbill and converting them to ICD-10 codes.
• Convert your most frequently used ICD-9 codes. Some practices have run a diagnosis productivity report and then converted their most frequently reported ICD-9 codes into ICD-10 codes (as shown below).
• Work your way through ICD-10’s Tabular List. At least one physician decided to start from scratch by sitting down with the ICD-10-CM for Ophthalmology book, reading through its Tabular List of codes, and noting the codes for the diagnoses that he most commonly sees.
• Adopt (and adapt) another practice’s superbill. You may be tempted to use a superbill that another practice has created (and is willing to share). However, you still need to double-check that their codes are all correct.

Converting the 20 Most-Used Codes

For the purpose of this article, a small-sized comprehensive ophthalmology practice ran a diagnosis productivity report to determine its 20 most-used ICD-9 codes. Savvy Coder converted those codes into their ICD-10 counter parts, which the practice can now use as the basis of its ICD-10 superbill.

How were the codes converted? ICD-10 codes are more specific than ICD-9 codes, which means your superbill will be replacing each ICD-9 code with multiple ICD-10 codes. One of the most efficient ways to do that is to use the ICD-10-CM for Ophthalmology Online Subscription (see “Online Tools, Reference Books, and Cheat Sheets”).

Cataract

366.15 Cortical senile cataract. This code is replaced by H25.01- Cortical age-related cataract. The dash (-) appears because this diagnosis has laterality in ICD-10, so instead of 1 code, there are 3—H25.011 (right eye), H25.012 (left), and H25.013 (bilateral).

366.16 Nuclear sclerosis. This is replaced by H25.1- Age-related nuclear cataract—H25.11 (right eye), H25.12 (left), and H25.13 (bilateral).

Tip. When you submit CPT code 66982 for complex cataract surgery, local coverage determinations (LCDs) require more than the traditional cataract diagnosis codes. To indicate why the surgery qualifies as complex, you also must report a second code. For more information, see the April 2015 Savvy Coder, “ICD-10 Codes for the Cataract Family.”

366.53 After-cataract, obscuring vision. There are no exact counterparts in ICD-10 for ICD-9’s 366.53, which is used for posterior capsular opacity, or 366.52 Other after-cataract, not obscuring vision. Instead, when submitting an exam code or CPT code 66821 for an Nd:YAG capsulotomy, report H26.49- Other secondary cataract—H26.491 (right eye), H26.492 (left), or H26.493 (bilateral).

V43.1 Lens replaced by other means (pseudophakia). While myopia and hyperopia have laterality in ICD10, pseudophakia does not. It has only 1 code: Z96.1 Presence of intraocular lens (pseudophakia).

Tip. If you’re looking for supporting documentation to indicate which eye, you may report Z98.41, which indicates that a cataract had been extracted from the right eye, and/or Z98.42 for the left eye. However, these codes are not required for payment.

Note. ICD-9 codes that start with V are used to report circumstances when something other than a disease or injury prompted the patient encounter. Under ICD-10, that function is performed by codes that start with Z. However, ICD-10 also has V codes, but they are used to report external causes of injury, such as accidents. For instance, in ICD-10, V43.1 is the diagnosis code for Passenger injured in collision with car, pick-up truck or van in non-traffic accident.

External Disease and Cornea

053.20 Herpes zoster dermatitis of eyelid. This ICD-9 code has just one ICD-10 counterpart. It is replaced by B02.39 Other herpes zoster eye disease (Zoster blepharitis).

372.00 Acute conjunctivitis, unspecified. This ICD-9 code is actually used for unspecified allergic conjunctivitis. Greater specificity exists in ICD-10. Your options are: 

• A54.31 Gonoccocal conjunctivitis
• A71.1 Active stage of trachoma
• A74.0 Chlamydial conjunctivitis
• B30.1 Conjunctivitis due to adenovirus
• B30.2 Viral pharyngoconjunctivitis
• B30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral)
• B60.12 Conjunctivitis due to Acanthamoeba
• H10.01- Acute follicular conjunctivitis 
• H10.02- Other mucopurulent conjunctivitis
• H10.1- Acute atopic conjunctivitis
• H10.21- Acute toxic conjunctivitis
• H10.22- Pseudomembranous conjunctivitis
• H10.23- Serous conjunctivitis, except viral
• H10.3- Unspecified acute conjunctivitis
• H10.40- Unspecified chronic conjunctivitis
• H10.41- Chronic giant papillary conjunctivitis
• H10.42- Simple chronic conjunctivitis
• H10.43- Chronic follicular conjunctivitis
• H10.44 Vernal conjunctivitis
• H10.45 Other chronic allergic conjunctivitis
• P39.1 Neonatal conjunctivitis and dacryocystitis

372.72 Conjunctival hemorrhage (subconjunctival hemorrhage). This is replaced by H11.3- Conjunctival hemorrhage (subconjunctival hemorrhage)—H11.31 (right eye), H11.32 (left), and H11.33 (bilateral).

373.00 Blepharitis. ICD-10 identifies 3 different types of blepharitis: H01.00- Unspecified, H01.01- Ulcerated, and H01.02- Squamous. While a dash is frequently used to indicate that a family of codes has laterality, for these blepharitis codes it indicates “liderality,” which means you have to report which lid was affected. As the sixth character, use a 1 for right upper eyelid, 2 for right lower, 4 for left upper, and 5 for left lower. There is no code for bilateral blepharitis.

Note. The 3 types of blepharitis have an Excludes1 note: None of them are billable the same day as H10.5- blepharoconjunctivitis.

373.11 Hordeolum (stye). This is replaced with H00.01- Hordeolum externum—H00.011 (right upper eyelid), H00.012 (right lower), H00.014 (left upper), and H00.015 (left lower).

373.32 Contact and allergic dermatitis of eyelid. This is replaced with H01.11- Allergic dermatitis of eyelid— H01.111 (right upper eyelid), H01.112 (right lower), H01.114 (left upper), and H01.115 (left lower).

Note. There is an Excludes1 note that precludes you from using an H01.11- code on the same day for the same eye as an H10.5- Blepharitis code.

375.15 Dry eye syndrome. This is replaced with H04.12- Dry eye syndrome—H04.121 (right lacrimal gland), H04.122 (left), and H04.123 (bilateral).

Tip. H04.12- has an Excludes1 note indicating that you can’t bill any of these codes on the same day and for the same eye as you bill any of the codes for congenital malformations of lacrimal system (Q10.4-Q10.6). Practices might consider adding an asterisk on the superbill to indicate that this is a stand-alone diagnosis (i.e., *H04.12 1, 2, 3 from the dry eye family).

918.1 Corneal abrasion. This code is replaced by 4 codes for Injury of conjunctiva and corneal abrasion without foreign body—S05.01XA (if the injury is in the right eye [1] and you are reporting the initial patient encounter [A]), S05.01XD (right eye [1], subsequent encounter [D]), S05.02XA (left eye [2], initial encounter [A]), and S05.02XD (left eye [2], subsequent encounter [D]).

Note. ICD-10 codes for injury and trauma require you to include one of the following as the code’s seventh character: A, for the initial patient encounter; D, for a subsequent encounter; or, where relevant, S, for sequela.

Glaucoma

365.01 Glaucoma suspect. This code is replaced with H40.00- Preglaucoma, unspecified—H40.001 (right eye), H40.002 (left), and H40.003 (bilateral).

Note. There is an Excludes1 note that applies to the H40 family of codes, including the H40.00- codes mentioned above and the H40.05- and H40.11X- codes mentioned below. This note indicates that you can’t bill those codes on the same day and for the same eye as absolute glau-coma (H44.51-), congenital glaucoma (Q15.0), or traumatic glaucoma due to birth injury (P15.3).

365.04 Ocular hypertension. This code is replaced by H40.05- Ocular hypertension—H40.051 (right eye), H40.052 (left), and H40.053 (bilateral). Those codes include laterality, but, of course, no staging.

365.11 Primary open-angle glaucoma (POAG). ICD-10 replaces this code with 4 options:

• H40.11X1 POAG, mild stage
• H40.11X2 POAG, moderate stage
• H40.11X3 POAG, severe stage
• H40.11X4 POAG, indeterminate stage

Tip. Not all ICD-10 codes have laterality, and not all of them require staging. For instance, POAG requires staging but does not have laterality. For help in selecting the right code, there is a 4-page document that includes the visual field indicators to determine staging.

Retina and Vitreous

250.0 Diabetes mellitus. Coding for patients with diabetes will require the greatest paradigm shift. There is no equivalent to ICD-9’s 250.0, and some of the terms that you currently use in the charts—such as “NIDDM,” “controlled,” and “uncontrolled”—will not be relevant to the new diagnosis codes.

Your choice of ICD-10 code will depend on whether the diabetes is type 1 or type 2, on whether macular edema is present, and on whether diabetic retinopathy is proliferative or nonproliferative (see the “ICD-10 Codes for Diabetic Retinopathy” chart). There is no laterality to the diabetes family of ICD-10 codes.  

Tip. Update your intake form to make sure that staff capture the type of diabetes.

362.03 Nonproliferative diabetic retinopathy NOS. Use the “ICD-10 Codes for Diabetic Retinopathy” chart to see which of the new diagnosis codes you should use.

Tip. The key is to properly link the type of diabetes to each test and surgery.

362.51 Dry macular degeneration. The ICD-10 counterpart to this code is H35.31 Nonexudative age-related macular degeneration.

Tip. There is no laterality for H35.31 Nonexudative AMD or for H35.32 Exudative AMD. Or, to put it another way: Whether wet or dry, ICD-10 doesn’t specify which eye.

379.24 Vitreous floaters. This is replaced by 6 codes: 3 are for H43.81- Vitreous degeneration (vitreous detachment)—H43.811 (right eye), H43.812 (left), and H43.813 (bilateral); 3 are for H43.39- Vitreomacular adhesion (vitreomacular traction)—H43.391 (right eye), H43.392 (left), and H43.393 (bilateral).

Vision Exam

367.1 Myopia. When coding for vision exams, ICD-9’s 367.1 is replaced by H52.1- Myopia—H52.11 (right eye), H52.12 (left), and H52.13 (bilateral).

Tip. While H52.1- Myopia and H52.0- Hypermetropia both have laterality, presbyopia only has one code: H52.4.

Coding for External Causes

Good news—you won’t need to code your encounter with a whale! CMS recently stated that the use of ICD-10’s external cause codes will not be mandatory. Chapter 20, which lists external causes of morbidity, will help you code your encounter with an orca (W56.2-); however, it will only be necessary if a commercial or other payer requires it to be submitted on your claim form.

According to one CMS article, if external cause codes have not been used with ICD-9, they will not be required in ICD-10 unless a new state or payer-based requirement is instituted.¹

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1 MLN Matters, SE1518, Use of External Cause and Unspecified Codes in ICD-10-CM. Accessed June 26, 2015.