• Creating an ICD-10 Superbill, Part 1


    No doubt one of the most challenging components to transitioning to ICD-10 is the development of the paper superbill. There are options:

    1. Many practices take the diagnosis codes on their existing superbill and convert those diagnoses to ICD-10 using the ICD-10-CM for Ophthalmology Online Subscription;
    2. Others run a diagnosis productivity report, which is an actual reflection of the diagnosis codes most often reported, and then convert them to ICD-10, using the ICD-10-CM for Ophthalmology Online Subscription;
    3. At least one physician decided to start from scratch by reading the Tabular List of the ICD-10-CM for Ophthalmology book and selected the diagnosis codes he typically sees;
    4. Adopt a superbill someone else has created and is willing to share.

    For the purposes of this article, I chose option 2.

    There are 207 ICD-9 codes on AAOE Chair Nancy Baker’s existing superbill. However, for greater accuracy, Nancy shared the top 20 diagnosis codes her comprehensive ophthalmologists report. The top 10 are addressed in this article. Part 2 will continue next month.

    The Top Ten

    Top 10 ICD-9 codes reported are:

    1. 366.16  Cataract, nuclear sclerotic
    2. 250.00  Diabetes
    3. 375.15  Dry eye syndrome
    4. 365.11  Primary open-angle glaucoma
    5. V43.1  Pseudophakic
    6. 379.24  Vitreous floaters
    7. 365.04  Ocular hypertension
    8. 366.53  Posterior capsular opacity
    9. Blepharitis
    10. 367.1  Myopia

    The process is tedious and at times frustration. But, remember—you’ll only have to do it once!

    366.16 Cataract, nuclear sclerotic

    The ICD-10 equivalent is H25.1 - Age-related nuclear cataract. Cataracta brunescens. The dash (-) indicates there is laterality. So, instead of one code, there are three:

    1. H25.11 Age-related nuclear cataract, right eye
    2. H25.12 Age-related nuclear cataract, left eye
    3. H25.13 Age-related nuclear cataract, bilateral

    Rather than having 3 separate lines on the superbill, consider listing H25.1 1,2,3 on a single line. When diagnosing bilateral cataracts, the physician would circle “3.”

    250.00 Diabetes

    There is no direct crosswalk equivalent in ICD-10. Coding persons with diabetes requires the greatest paradigm shift. Diabetes is identified by Type 1 E10 or Type 2 E11. There is no laterality to the diabetes family.
    Type 1 without complications is reported as E10.9. Type 2 without complications is reported as E11.9.

    375.15 Dry eye syndrome

    The ICD-10 equivalent is H04.12 -. The dash (-) indicates there is laterality. Once again, there are three ICD-10 codes as identification of the eye(s) is required.

    1. H04.121 Dry eye syndrome of right lacrimal gland (Tear film insufficiency, NOS)
    2. H04.122 Dry eye syndrome of left lacrimal gland (Tear film insufficiency, NOS)
    3. H04.123 Dry eye syndrome of bilateral lacrimal glands (Tear film insufficiency, NOS)

    Note: H04.12- has an Excludes1 Note indicating that congenital malformations of lacrimal system (Q10.4-Q10.6) cannot be billed on the same eye/same day. Practices might consider adding a (*) on the superbill to indicate this is a stand-alone diagnosis: *H04.12 1, 2, 3 from the dry eye family.

    365.11 Primary open-angle glaucoma

    The ICD-10 equivalent to 365.11 offers four options:

    1. H40.11X1 Primary open-angle glaucoma, mild stage
    2. H40.11X2 Primary open-angle glaucoma, moderate stage
    3. H40.11X3 Primary open-angle glaucoma, severe stage
    4. H40.11X4 Primary open-angle glaucoma, indeterminate stage

    The tricky part about ICD-10 for glaucoma is that not all diagnoses have laterality and not all codes require staging. Primary open-angle glaucoma requires staging, but does not have laterality. As the staging indicator must be in the 7th position, X is in the 6th position as a placeholder.

    Coding Tip: All glaucoma diagnoses can be downloaded in a 4-page document which includes the visual field indicators to determine staging. The  Glaucoma ICD-10 Quick Reference Guide can be downloaded from the ICD-10 “Resources and Seminars” section of the website. 

    V43.1 Pseudophakia

    While myopia and hyperopia have laterality, pseudophakia does not. It only has one code from Chapter 21 in the ICD-10-CM for Ophthalmology book: Z96.1 Presence of intraocular lens (pseudophakia). Caution: If you turn on your ICD-10 codes too soon in your claims software, you’ll find that the current V43.1 Pseudophakia code in ICD-10 is Passenger injured in collision with car, pick-up truck or van in non-traffic accident.

    If you’re looking for supporting documentation to indicate which eye, you may report Z98.41 indicating cataract extraction status of the right eye and/or Z98.42 for the left eye. However, these codes are not required for payment.

    379.24 Vitreous floaters

    H43.811 represents vitreous degeneration, right eye (PVD), and H43.812 for the left eye, or H43.813 for bilateral PVD.

    H43.391 represents floaters, vitreous, right eye, and H43.392 left eye, or H43.393 for both eyes.

    So, it is surprising that other subjective visual disturbance (flashes) only has one code H53.19.

    365.04 Ocular hypertension

    There is laterality, but of course, no staging for the ICD-10 equivalent of ocular hypertension. H40.051 Ocular hypertension, right eye, or H40.052 Ocular hypertension, left eye, or H40.053 - Ocular hypertension, bilateral.

    Note: There is an Excludes1 Note indicating that ocular hypertension can’t be reported the same day/same eye as absolute glaucoma (H44.51-), congenital glaucoma (Q15.0), traumatic glaucoma due to birth injury (P15.3).

    366.53 Posterior capsular opacity

    Surprise! There is no exact direct crosswalk in ICD-10. Rather than 366.52 Other after-cataract, not obscuring vision, or 366.53 After-cataract, obscuring vision, there is only one option in ICD-10. When submitting an exam or CPT code 66821 for a YAG capsulotomy, use:

    1. H26.491 Other secondary cataract, right eye,
    2. H26.492 for the left eye, or
    3. H26.493 for bilateral other secondary cataract.

    373.00 Blepharitis

    H01 Other inflammation of eyelid begins with H01.0 as the chapter header for blepharitis. ICD-10 identifies three different types of blepharitis:

    1. Unspecified H01.00-,
    2. Ulcerated H01.01- and
    3. Squamous.H01.02- 

    The dash for this family of codes refers to a new term we call “liderality,” not laterality. When liderality is required for reporting, a “1” in the last position represents the right upper lid. A “2” in the last position represents the right lower lid. A “4” indicates the left upper lid. And a “5” indicates the left lower lid. It’s sadly true. There is no code for bilateral blepharitis.

    When listing unspecified blepharitis on the superbill, it might look like this H01.00 1,2,4,5. If blepharitis is found on the right and left upper lids, the physician would circle the 1 and the 4.

    Note: Unspecified, ulcerative, and squamous blepharitis has an Excludes1 Note. None of the 3 types are billable the same day as blepharoconjunctivitis H10.5-.

    367.1 Myopia

    When coding vision exams, the ICD-10 equivalent is H52.11 Myopia right eye, H52.12 Myopia left eye and H52.13 for bilateral myopia.

    Hyperopia also has laterality. H52.01 Hypermetropia right eye. H52.02 Hypermetropia left eye, or H52.03 Hypermetropia bilateral.

    But, only presbyopia has one code: H52.4!

    Good News

    No need to code your encounter with a whale per the Centers for Medicare and Medicaid Services (CMS).

    CMS recently stated that the use of external cause codes in ICD-10 will not be mandatory. Chapter 20 External causes of morbidity will help you code your encounter with an orca, W562-, however, it will only be necessary if a commercial or other payer requires it to be submitted on your claim form. Per the MLN article SE1518, if these codes have not been used with ICD-9, they will not be required in ICD-10.

    Valuable Resources

    Anticipating the complexity of this process, the Academy has developed many resources to aid the process. Numerous quick reference guides by specialty can be downloaded from the ICD-10 “Resources and Seminars” section of the website. ICD-10-CM Online Subscription is the tool used to create the crosswalks in this article. The ICD-10-CM for Ophthalmology book is also a great resource. Look for the 2016 version available to order in the Academy Store July 1.

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