By Jenny Edgar, CPC, CPCO, OCS, OCSR, Academy Manager of Coding and Reimbursement, and Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement
December 2020 Savvy Coder, published online ahead of print.
On Oct. 1, 2020, many new and revised ICD-10-CM codes went into effect, including the addition of laterality to the corneal dystrophy and corneal transplant codes.
Altogether, there are 80 changes that impact ophthalmology. Although many of the edits are minor, be sure you know what has changed (see “Don’t Miss Out on These ICD-10 Resources”). Failure to submit a diagnosis code in its entirety will lead to claim rejection, causing a delay in payment.
Corneal Dystrophy: H18.5-
As previously, the fifth character of corneal dystrophy’s ICD-10 code (H18.5-) represents the type of dystrophy:
H18.50- Unspecified hereditary
H18.52- Epithelial (juvenile)
H18.59- Other hereditary
What’s new is that the sixth character now indicates laterality:
1 for the right eye
2 for the left eye
3 for both eyes
For example, a patient diagnosed with bilateral Fuchs dystrophy would be identified by H18.513.
Corneal Transplant: T86.84-
As previously, the sixth character of the ICD-10 code for a corneal transplant (T86.84-) indicates type of transplant:
T86.848- Other complication
T86.849- Unspecified complication
But now the seventh character indicates laterality—1, 2, or 3 to represent the right eye, left eye, or both eyes, respectively.
For example, T86.8421 indicates that a patient is diagnosed with a corneal transplant infection in the right eye.
Further changes that might be relevant to your practice include the following.
R51.-: Headache. If ICD-10 changes are giving you a headache, make sure that you are coding it correctly, as a fourth character has been added:
- 0 Headache with orthostatic component, not elsewhere classified
- 9 Headache, unspecified
H55.8-: Other irregular eye movements. There were two changes to the H55.8- family of codes:
- 81’s definition is now Deficient saccadic eye movements (previously, it had been Saccadic eye movements)
- 82 is a new code, defined as Deficient smooth pursuit eye movements
U07.-: Two new codes for 2020. Released prior to October, the following codes may be applicable to some practices:
- 0 Vaping-related disorder
- 1 COVID-19
While federal payers implemented these codes on Oct. 1 (apart from the two U07 codes, which were implemented earlier), others may be slower to adopt them. You should therefore:
- Check payer policies, including Medicare Administrative Contractor local coverage determinations (LCDs), to see if they have been updated (see “Don’t Miss Out on These ICD-10 Resources,” below).
- Make sure that you provide the new diagnosis code when seeking prior authorization.
What if a claim is denied as not medically necessary? This may mean the ICD-10 code has not yet been uploaded or assigned a CPT code by that particular payer. Contact your provider representatives for a timeline and consider providing them with supporting documentation.
Don’t Miss Out on These ICD-10 Resources
The American Academy of Ophthalmic Executives (AAOE) has developed a wealth of ICD-10 resources.
Get the AAOE’s free ICD-10 materials. Visit aao.org/icd10 and make sure you have the latest versions of the AAOE’s subspecialty-specific guides to ICD-10 codes, including two new cornea decision trees that are available to download. You also can find a listing of other diagnosis codes that may impact your ophthalmology practice.
Get the latest local coverage determinations (LCDs). Visit aao.org/lcds to get the LCDs that apply to you.
Buy 2021 ICD-10-CM for Ophthalmology: The Complete Reference. Visit aao.org/codingproducts to buy the updated ICD-10 reference for ophthalmology. It features a complete list of all ICD-10 diagnosis codes that are relevant for eye care, along with instructions on how to use them.
Attend Codequest for state-specific information. Visit aao.org/codequest to see when the AAOE’s coding experts will be discussing your state.
Got questions? When ophthalmology practices have a coding conundrum, they can request help by emailing email@example.com or firstname.lastname@example.org.
For AAOE members. If you are an AAOE member, you can use the AAOE eTalk listserv to crowdsource answers to your coding conundrums (aao.org/practice-management/listserv). If you’re not a member, join at aao.org/membership/join-aaoe.