Transcript ICD-10 Ready? - My Vision Express

ICD-10 Ready?
My Vision Express presents
An introduction to the new coding system
ICD-9 Guidelines
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5th digit specificity for certain codes.
Reporting two codes when required, instead of just one.
Combination codes (reporting one code for two conditions)
Coding for late effects
Reporting E codes, one for the injury, and one for the location
of the injury.
 Reporting E codes for adverse effects.
 Screening V codes (V72.0)
ICD-9 vs. ICD-10
 ICD-9 has 13,000 codes compared to the new 68,000 ICD 10 codes.
 Laterality as well as bilateral anatomy and disease codes have been
added to the coding system.
 ICD 9 codes have been merged to create one ICD 10 code.
 Other ICD-9 codes have been split into two ICD-10 codes.
ICD-10 Format and Organization
 ICD-10 consists of 3 to 7 characters. The first character is an alpha
character, the second is numeric, and the rest can either be alpha
or numeric.
ICD-10 Format and Organization
ICD-10 consists of 3 to 7 characters. The first character is an alpha
character, the second is numeric, and the rest can either be alpha or
numeric.
H00-H05
H10-H11
H15-H22
H25-H28
H30-H36
H40-H42
Disorders of the eyelid, lacrimal system, and orbit
Disorders of the conjunctiva
Disorders of the sclera, cornea, iris, and ciliary body
Disorders of the lens
Disorders of the choroid and retina
Glaucoma
ICD-10 Format and Organization
H43-H44
H46-H47
H49-H52
H53-H54
H55-H57
H59
Disorders of the vitreous body and globe
Disorders of the optic nerve and visual pathways
Disorders of ocular muscles, binocular movements,
accommodation, and refraction
Visual disturbances and blindness
Other disorders of the eye and adnexa
Intraoperative and post procedural complications and
disorders of eye and adnexa, not elsewhere classified
Laterality
 Report eye conditions by eye when applicable.
 Certain codes such as Lid codes will contain upper and lower lid
coding.
 Other codes will have no laterality.
E08.321 Diabetes mellitus due to
underlying condition with mild
nonproliferative diabetic
retinopathy with macular edema
E08.329 Diabetes mellitus due to
underlying condition with mild
nonproliferative diabetic
retinopathy with macular edema
XXX.XX1 = Right eye
XXX.XX2 = Left Eye
XXX.XX3 = Bilateral
XXX.XX9 = Unspecified eye (not recommended)
Placeholder Codes
 Certain codes will contain an “X” as a sixth-digit placeholder. This
keeps the seventh character in the correct position.
 Most common in injury and glaucoma codes.
 If the placeholder is not included, it will result in an invalid code.
ICD-10 Code for POAG:
ICD- 9 Code for
Primary Open
Glaucoma (POAG):
365.10
H40.11X0 POAG Stage Unspecified
H40.11X1 POAG Mild Stage
H40.11X2 POAG Moderate Stage
H40.11X3 POAG Severe Stage
H40.11X4 POAG Indeterminate
Stage
Occurrence Codes
 Occurrence codes are included in injury codes along with
placeholder codes.
 Injury codes will have three different occurrence codes:
Initial
Subsequent
Sequela
ICD- 9 Code for
Corneal foreign
body:
930.0
ICD-10 Code for Foreign body in
cornea:
T15.00XA Foreign body in cornea,
initial encounter
T15.00XD Foreign body in cornea,
subsequent encounter
T15.00XS Foreign body in cornea,
sequela
Initial Encounter
 Initial encounters are not limited to the very first encounter for a
new condition.
 This can be used for multiple encounters as long as the patient
receives active treatment for the condition.
 Active Treatment:
Initial evaluation of the condition.
Surgical treatment
Evaluation and continuing treatment by the same or a different
physician.
Subsequent encounter
 Subsequent encounters is after the patient has received active
treatment of the condition and is receiving routine care for the
condition during the healing or recovery phase.
 Subsequent care:
Cast change or removal, removal of external or internal fixation
device, other aftercare and follow up visits following treatment of
the injury or condition.
Sequela, Late Effect
 Sequela are conditions that arise as a direct result of a condition
(rust ring after a foreign body removal).
 This is a condition produced after the acute phase of an illness of
injury has terminated. A wound infection or an acute
complication is not the same.
 It is necessary to use the code that triggered the sequela (ex:
foreign body removal) and the code for the sequela itself (rust
ring).
T15.01XA Foreign body in cornea, right
eye, sequela
Exclude 1 Notes
 Excludes 1: Indicates that code identified in the note and code
where the note appears cannot be reports together because the
2 conditions cannot occur together.
H40.021 Open angle with
borderline findings, high risk
Type 1 Excludes:
H41.51- Absolute Glaucoma
Q15.0 - Congenital Glaucoma
P15.3 - Traumatic glaucoma due to birth injury
Exclude 2 Notes
 Excludes 2: Indicates that condition identified in the note is not
part of the condition represented by the code where the note
appears, so both codes may be reported together if the patient
had both conditions.
H00.11 Chalazion, right upper
eyelid
Type 2 Excludes:
S01.1- Open wound of eyelid
S00.1- , S00.2- Superficial injury of eyelid
Refractive Codes
 Each code will have four codes instead of one.
 These codes should be used with 92015 and are not considered
medical diagnosis.
 Some medical insurance carriers may pay on medical diagnosis
pointing to 92015.
Exceptions:
Presbyopia(No laterality) H52.1
Anisometropia(No laterality)
H52.31
Aniseikonia (No laterality) H52.32
ICD-9 for Myopia:
367.1
H52.11, Myopia, right eye
H52.12, Myopia, left eye
H52.13, Myopia, bilateral
H52.19, Myopia, unspecified (not
recommended)
Routine Eye Exam
 V72.0, routine exam of eyes changes to two codes:
 Z01.00 Encounter for examination of eyes and vision without
abnormal findings.
 Z01.01 Encounter for examination of eyes and vision with
abnormal findings.
 Individual carriers or vision plans may have different
requirements.
 Office visits should be linked to Z01.00 or Z01.01 when necessary.
Eyelid Codes
 Seven codes are available for Eyelid codes.
ICD-9 for Retained foreign
body of eyelid is 374.86
H02.811 Retained foreign body in right upper
eyelid
H02.812 Retained foreign body in right lower
eyelid
H02.813 Retained foreign body in right eye,
unspecified eyelid (not recommended)
H02.814 Retained foreign body in left upper eyelid
H02.815 Retained foreign body in left lower eyelid
H02.816 Retained foreign body in left eye,
unspecified eyelid (not recommended)
Injury Codes
 When documenting injuries, include:
Episode of Care
Injury site
Etiology
Place of Occurrence
S05.51XA Penetrating wound with foreign body of right eyeball, initial
encounter
S05.51XD Penetrating wound with foreign body of right eyeball,
subsequent encounter
S05.51XS Penetrating wound with foreign body of right eyeball, sequela
Injury Codes
 Documentation components
Chief complaint
HPI (History of Present Illness)
ROS (Review of Systems)
PFSH (Patient, Family, Social History)
Medical Decision Making
Lacrimal Gland Codes
 Lacrimal codes follow the same guidelines as eyelid codes where
they specify location.
Dry eye syndrome
375.15
H04.121, Dry eye of right lacrimal gland
H04.122, Dry eye of left lacrimal gland
H04.123, Dry eye of bilateral lacrimal glands
H04.129, Dry eye of unspecified lacrimal gland
Diabetic codes without manifestation
250.00 DM II, controlled
E11.9 Type 2 diabetes mellitus
without complications
250.01 DM I, controlled
E10.9 Type 1 diabetes mellitus
without complications
250.02 DM II, uncontrolled
E11.65 Type 2 diabetes
mellitus with hyperglycemia
250.01 DM I, controlled
E10.65 Type diabetes mellitus
with hyperglycemia
Diabetic Retinopathy
 Two codes were needed when reporting ICD-9 diabetic retinopathy
codes.
 Diabetic codes in ICD-10 no longer need two reported.
250.51 Diabetes with
ophthalmic
manifestations, type I
362.04 Diabetic
retinopathy: mild
nonproliferative
diabetic retinopathy
E10.321 Type 1 diabetes mellitus
with mild nonproliferative diabetic
retinopathy with macular edema
E10.329 Type 1 diabetes mellitus
with mild nonproflierative diabetic
retinopathy without macular edema
Claim Examples
ICD 9 Example: Medical visit with Fundus Photos, Gonio, Pach, and Refraction.
Claim Examples
ICD 10 Example: Medical visit with Fundus Photos, Gonio, Pach, and Refraction.
Post-Op Glasses
Aphakia
ICD9: 379.31
ICD10:
H27.00 Aphakia unspecified
H27.01 Aphakia, Right eye
H27.02 Aphakia, Left eye
H27.03 Aphakia, Bilateral
Congenital Aphakia
ICD9: 743.35
ICD10: Q12.3 Congenital Aphakia
Lens replaced by other means
ICD9: V43.1 Lens replaced by other means
ICD10: Z96.1 Presence of intraocular lens
Post-Op Glasses
Questions?
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Is MVE ready for ICD-10?
Yes. File > Setup> Company > System > Diagnosis will translate all ICD-9 codes
to its 10 equivalent.
Will ICD-10 replace CPT coding?
The transition does not affect CPT coding for outpatient procedures and physician
services.
Who is affected?
Health care providers and payers who do not do Medicare claims and anyone who
is covered by HIPAA.
Are both 9 and 10 codes needed during the transition?
Only until all claims and other transactions for services before October 1, 2015,
have been processed and completed. It is best to contact your clearinghouse and
insurances you take for further information.
What happens if I process claims with ICD-9 codes after October 1st?
Claims that do not have the appropriate ICD-10 codes will not be processed.
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