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Ophthalmic Professional

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Coding

ICD-10: It's not over yet

By: PAUL M. LARSON, MBA, MMSC, COMT, COE, CPC, CPMA
Ophthalmic Professional July 1, 2016 Vol 5, Issue July 2016 Page(s): 40, 41
Coding

ICD-10: It’s not over yet

A look at the recently released 2017 annual updates.

BY PAUL M. LARSON, MBA, MMSC, COMT, COE, CPC, CPMA

When ICD-10 debuted in October 2015, the rollout was not without a few small bumps, but thankfully most got resolved rather quickly. I’ve heard ICD-10 referred to as “Y2K,” and that’s been a good analogy — but, in this case, the problems were solved with a lot of hard work and training.

One of the little-known provisions of the rules was a code freeze put into place that lasted through Sept. 30, 2015.1,2 The implication was that no codes would change during the rollout but that regular updates would resume with the 2017 ICD-10 code set, which becomes active on Oct. 1, 2016. That day is fast approaching.

ICD-10 problem areas

Some 2016 ICD-10 are a bit of a “head-scratcher.” Three often-cited examples are:

• Open angle glaucoma codes that have no right eye/left eye designation but have a “staging” designation.

• Diabetic retinopathy coding did not have laterality.

• “Wet” and “dry” macular degeneration codes did not have laterality.

There is good news and bad news for 2017. First, the good news: Right eye/left eye/bilateral remains for the most part as “1,” “2,” and “3,” respectively. Also, most of the aforementioned head-scratchers will be deleted as of Oct. 1, 2016 and replaced with codes that have laterality. The bad news? You have to be ready to use the new, proposed codes on Oct. 1, 2016 and can no longer use, for example, H35.31 (for dry AMD) after this date.

Noteworthy 2017 changes

Here are the basic changes you should know (See Table 1 for a sampling of some of these codes):

Table 1. 2016 vs 2017 ICD-10 for eye care
2016 PROPOSED FOR OCT. 1, 2016

H35.31 (Dry AMD)

H35.32 (Wet AMD)

H35.3112 (Non-exudative AMD, OD, intermediate stage)

H35.3222 (Exudative AMD, OS, inactive)

• Eye is sixth character (wet or dry).

• AMD stage or activity is seventh character (wet or dry).

E11.329 (Type II DM, Mild NPDR, no DME)

H33.41 (Traction RD of retina OD)

H33.01 (Rhegmatogenous RD w/ single break OD)

E11.3293 (Type II DM, mild NPDR, no DME, bilateral)

E11.3532 (Type II DM, PDR, traction RD not involving macula, OS)

E11.3521 (Type II DM, PDR, traction RD involving macula, OD)

E11.3541 (Type II DM, PDR, combined traction RD & rhegmatogenous RD, OD)

• Eye is seventh character.
H40.11x2 (OAG, Moderate stage)

H40.1122 (OAG, OS, Moderate stage)

H40.1132 (Moderate stage OU, OAG)

• Eye is sixth character.

• Staging is still seventh character as before.

H34.811 (CRVO, OD)

H34.8110 CRVO, OD, with ME

H34.8111 CRVO, OD, with retinal neovascularization

H34.812 CRVO, OD, stable

• Eye is sixth character.

• Seventh character: “0,” “1,” “2” for +/- ME or stable.

• All macular degeneration codes get laterality and staging. In wet AMD, there are options for active and inactive.

• Diabetic retinopathy codes get laterality.

• Proliferative diabetic retinopathy codes now have “tractional” and “rhegmatogenous” retinal detachment options.

• Open-angle glaucoma codes get laterality.

• Central branch retinal vein occlusion and branch retinal vein occlusion coding is slightly changed.

There are a large number of additional code changes; the American Academy of Professional coders notes there are “1,900 new ICD-10-CM codes proposed for the October 2017 release. Of that number, there are 313 deletions and 351 revised codes.”3 You don’t need to know them all, but you can access the proposed list on the Centers for Disease Control and Prevention (CDC) website.4

Conclusion

Annual diagnosis coding updates have resumed, and some changes to ICD-10 will take place every year moving forward. New codes will be added while others deleted. Stay current with the changes that affect eye care, and monitor your documentation and claims. OP

REFERENCES:

1. Federal Register. Vol. 79, No. 149. August 4, 2014. https://www.gpo.gov/fdsys/pkg/FR-2014-08-04/pdf/2014-18347.pdf. Accessed May 25, 2016.

2. Centers for Medicare & Medicaid Services (CMS). Partial Code Freeze for ICD-9 and ICD-10. https://www.cms.gov/medicare/coding/icd10/downloads/partial_code_freeze.pdf. Accessed May 25, 2016.

3. American Association of Professional Coders. Prepare for Thousands of ICD-10 Code Changes. https://www.aapc.com/blog/34105-prepare-for-thousands-of-icd-10-code-changes. Accessed May 25, 2016.

4. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm. (See FY2017 New Released ICD-10-CM codes link). Accessed May 25, 2016.

Mr. Larson is a senior consultant at Corcoran Consulting Group. He specializes in coding and reimbursement. Mr. Larson is based in Atlanta.

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