As you continue to learn and use the new, expanded ICD-10 codes that took effect Oct. 1, 2016, pay particular attention to these three significant revisions.
1. New Retinal Vein-Occlusion Specificity
Diagnosis codes for branch and central retinal vein occlusion now require staging, which is specified in the seventh character. Note the staging in addition to laterality, which is specified in the sixth character.
Because the code now requires staging, you can now code vein occlusion with macular edema more efficiently. For instance, a diagnosis of BRVO with macular edema in the right eye is now combined into one code:
H34.831—BRVO, right eye
H35.351—Cystoid macular edema
H34.8310—BRVO with macular edema, right eye
2. New AMD Specificity
The ICD-10 changes also increased specificity in the two codes used for AMD — dry (H35.31) and wet (H35.32).The diagnosis codes now include laterality and staging, which gives you 21 ways to describe the case treated. Specify laterality in the sixth character, stage in the seventh. Consult the Academy’s new AMD decision tree for full details.
H35.31 Nonexudative age-related macular degeneration
H35.3111 Nonexudative age-related macular degeneration, right eye, early stage
Note: In addition to changing your coding practices for these cases, you should also review your documentation carefully. For example, if your chart notes only say “dry AMD in the right eye,” you will need to write additional information on the staging in order to correctly code the case. In this example, “intermediate dry AMD in the right eye” would suffice.
3. Coding for Diabetic Retinopathy
The ICD-10 code changes also expand your options for proliferative diabetic retinopathy. As Wilkin Parke III, MD, notes in his guide to “classifying the diabetic eye,” ophthalmologists treat diabetic retinopathy and diabetic macular edema as “distinct, parallel disease processes.” When coding from the expanded PDR options that took effect Oct. 1, be aware that using two codes might sometimes more accurately reflect your diagnosis.
For example, if you have a patient with type 1 diabetes and stable PDR following panretinal photocoagulation and diabetic macular edema in the left eye, you would now use two codes.
E10.3512, PDR with macular edema
E10.3552 Stable PDR and
E10.3512 PDR with macular edema
Review the Academy’s revised diabetic retinopathy decision tree for full details.
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About the author: Joy Woodke, COE, OCS, is a practice administrator at Oregon Eye Consultants, LLC, in Eugene, Ore., a five-physician practice specializing in anterior segment, uveitis, cornea and retina. She has over 25 years of experience in ophthalmology, which includes management, accounting and ophthalmic coding and reimbursement. She also serves as the chair of the American Academy of Ophthalmic Executives’ EHR Committee.