Cracking the Ophthalmology and Optometry Codes in ICD-10

Picture this; a patient comes to you from a vacation with a corneal abrasion. At present, as a coder using ICD-9 you would simply use the code for corneal abrasion; however, things will not remain as easy with the onset of ICD-10. Then, you would have to select from a wide-range of codes –from unspecified injury of right eye and orbit (S05.91) to abrasion of eyelid and periocular area (S00.21), abrasion of right eyelid and periocular area to struck by macaw (W61.12xA) and struck by other psittacines (W61.22xA).

Sounds complicated? Yes, ICD-10 is more detailed, and it emphasizes on highest level of specificity in documentation so much so that the there are 69,000 new codes in the book as compared to 14,000 in ICD-9. Things are going to get very detailed with the ICD-10 transition, and this will instigate precise diagnosis with accurate documentation that will lead to proper payment for the providers.

Here are some handy tips to finding the right code in ICD-10:

ICD-10 Terminology

ICD-10 uses its own set of terms that may have different meanings, such as, “excludes” is often used in the book and it’s been used in two different ways— Excludes 1 and Excludes 2, the former means two codes are incompatible and cannot be used together on a claim. In contrast, “Exclude 2”means that another code isn’t included with the particular code you’re looking at but it can coexist at the same time in the same patient.

Specifying Laterality

ICD-10 stresses on specifying laterality in its codes, unlike ICD-9.

For instance,

1 is the right eye;
2 is the left;
3 indicates bilaterality; and
9 means the side is unspecified.

ICD-10 and the 7th Digit Representation

To be specific about the severity of the condition, ICD-10 requires that a seventh digit representation be coded as well. For e.g Glaucoma:

1 represents mild disease;
2 is moderate;
3 is severe;
0 is unspecified; and
4 means it is indeterminate.

21 Chapters of ICD-10

In ICD-10 book we have 21 chapters versus ICD-9’s 17, and the users need to know about them for coding any given patient. You can’t just learn the eye chapter (Chapter 7), and avoid the others. For instance, suppose your patient has a diabetic eye condition but if you look for it in chapter 7 you won’t find it because it’s covered in the chapter of endocrine system (Chapter 4).

ICD-10 is likely to pose many documentation, coding and technological challenges; however, one thing is clear: It won’t be delayed and will be required for reimbursement come October 2015. The time for excuses is over, keep preparing for this major overhaul. At AudioEducator, expert speaker Jeffrey Restuccio, CPC, CPC-H, MBA will take an audio session on ICD-10 for Ophthalmology and Optometry on May 07, 2015.

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