Last month, we identified some major characteristics of ICD-10-CM. This month, we build upon those principles and identify some additional ICD-10 nuances. Keep in mind that the best code is the actual diagnosis; the next best is a sign or symptom. Never code anything you only suspect — rule it out.
With and Without
Some systemic diseases that affect both eyes are identified by 1 (with) or 9 (without) as the last character.
E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E10.9 Type 1 diabetes mellitus without complications
G43.109 Migraine with aura, not intractable, without status migrainosus
When an Excludes2 is listed for a code, it means the patient may have both conditions at the same time. Therefore, you can submit both codes.
H25.- Age-related cataract
Excludes2: Capsular glaucoma with pseudoexfoliation of lens (H40.1-)
H18.82- Corneal disorder due to contact lens
Excludes2: Corneal edema due to contact lens (H18.21-)
The word “and” in the code listing should be interpreted as meaning “and/or.”
H26.032 Infantile and juvenile nuclear cataract, left eye
Certain diagnoses will require a seventh character, which is notated in the tabular list of ICD-10-CM for Ophthalmology.
Example 1: glaucoma codes
The seventh-place character may represent the stage of the patient’s glaucoma (although not every glaucoma diagnosis requires staging). Reference the tabular section of the ICD-10-CM book or the American Glaucoma Society’s Quick Guide to Glaucoma Coding to determine when the additional code is needed. When required, identify the stage by 0 (unspecified), 1 (mild), 2 (moderate), 3 (severe) and 4 (indeterminate). We previously discussed using the X placeholder as the sixth character; however, most diagnoses in glaucoma have laterality.
H40.2122 Acute angle-closure glaucoma, left eye, moderate stage
H40.2213 Chronic angle-closure glaucoma, right eye, severe stage
H40.032 Anatomical narrow angle, left eye
For the last code above, no stage is required, so there is no need for a seventh character or the X placeholder.
Example 2: trauma and injury codes
These code sets, which begin with an S or a T, can be found in chapter 19 of ICD-10-CM for Ophthalmology. They often require a seventh character identified by A (initial encounter), D (subsequent encounter) or S (sequela). Typically, the X placeholder will be included in these codes as well. Submit sequela encounters when the patient has a new condition resulting from a disease, injury or trauma.
T81.33XA Disruption of traumatic injury wound repair, initial encounter
H18.832 Recurrent erosion, left eye
S05.02XS Corneal abrasion, left eye, sequela encounter
You would submit these two codes together. The recurrent erosion is the sequela or condition resulting from the abrasion. The S is added to the corneal abrasion diagnosis because the tabular list requires the seventh character, which states the type of encounter.
T15.01XA Corneal foreign body, right eye, initial encounter
S05.12XD Traumatic hyphema, left eye, subsequent encounter
Key Facts for ICD-10
- ICD-10 will go into effect Oct. 1. Claims submitted on or after this date that have ICD-9 codes will be denied or rejected.
- Although Medicare Part B and commercial payers will implement ICD-10, third-party liability payers, including workers’ compensation, auto insurance and homeowner and business owner liability insurance, may not.
- You don’t need to have electronic health records to effectively code and bill ICD-10.
- Remember that searching for the code in the alphabetical index of the ICD-10-CM book is a starting place, but the tabular list will confirm if any additional characters are needed.
- Make sure to link the appropriate diagnosis with the correct CPT code, just like ICD-9.
For more ICD-10 resources, including Persons With Diabetes Physician Decision Tree, Glaucoma Quick-Reference Guide and Pediatric and Strabismus Quick-Reference Guide, visit the American Academy of Ophthalmic Executives website. Submit your ICD-10 questions to firstname.lastname@example.org.
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About the authors: Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Coding Bulletin, Ophthalmic Coding Coach and Ophthalmic Coding series. Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She oversees the Academy’s Chart Auditing Service and is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series.