my vision express presents an introduction to the new coding system icd-10 ready?
TRANSCRIPT
My Vision Express presentsAn introduction to the new coding system
ICD-10 Ready?
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 Guidelines
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-H05H10-H11H15-H22H25-H28H30-H36H40-H42
Disorders of the eyelid, lacrimal system, and orbitDisorders of the conjunctivaDisorders of the sclera, cornea, iris, and ciliary bodyDisorders of the lensDisorders of the choroid and retinaGlaucoma
ICD-10 Format and Organization
H43-H44H46-H47H49-H52H53-H54H55-H57H59
Disorders of the vitreous body and globeDisorders of the optic nerve and visual pathwaysDisorders of ocular muscles, binocular movements, accommodation, and refractionVisual disturbances and blindnessOther disorders of the eye and adnexaIntraoperative 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.
XXX.XX1 = Right eye XXX.XX2 = Left Eye XXX.XX3 = Bilateral XXX.XX9 = Unspecified eye (not recommended)
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
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- 9 Code for Primary Open Glaucoma (POAG):
365.10
ICD-10 Code for POAG:
H40.11X0 POAG Stage UnspecifiedH40.11X1 POAG Mild StageH40.11X2 POAG Moderate Stage H40.11X3 POAG Severe StageH40.11X4 POAG Indeterminate Stage
Occurrence Codes Occurrence codes are included in injury codes along with
placeholder codes. Injury codes will have three different occurrence codes:
InitialSubsequentSequela
ICD- 9 Code for Corneal foreign body:
930.0
ICD-10 Code for Foreign body in cornea:T15.00XA Foreign body in cornea, initial encounterT15.00XD Foreign body in cornea, subsequent encounterT15.00XS 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 treatmentEvaluation 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 GlaucomaQ15.0 - Congenital GlaucomaP15.3 - 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 eyelidS00.1- , 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) H52.1Anisometropia(No laterality) H52.31Aniseikonia (No laterality) H52.32
ICD-9 for Myopia:
367.1
H52.11, Myopia, right eyeH52.12, Myopia, left eyeH52.13, Myopia, bilateralH52.19, 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 eyelidH02.812 Retained foreign body in right lower eyelidH02.813 Retained foreign body in right eye, unspecified eyelid (not recommended)H02.814 Retained foreign body in left upper eyelidH02.815 Retained foreign body in left lower eyelidH02.816 Retained foreign body in left eye, unspecified eyelid (not recommended)
Injury Codes
When documenting injuries, include: Episode of CareInjury siteEtiologyPlace 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 encounterS05.51XS 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 glandH04.122, Dry eye of left lacrimal glandH04.123, Dry eye of bilateral lacrimal glandsH04.129, Dry eye of unspecified lacrimal gland
Diabetic codes without manifestation
250.00 DM II, controlled
250.01 DM I, controlled
E10.65 Type diabetes mellitus with hyperglycemia
250.02 DM II, uncontrolled
250.01 DM I, controlled
E11.9 Type 2 diabetes mellitus without complications
E10.9 Type 1 diabetes mellitus without complications
E11.65 Type 2 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
Lens replaced by other meansICD9: V43.1 Lens replaced by other meansICD10: Z96.1 Presence of intraocular lens
AphakiaICD9: 379.31ICD10: H27.00 Aphakia unspecified H27.01 Aphakia, Right eye H27.02 Aphakia, Left eyeH27.03 Aphakia, Bilateral
Congenital AphakiaICD9: 743.35 ICD10: Q12.3 Congenital Aphakia
Post-Op Glasses
Questions?
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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