Update software and make staff aware of the changes.

Another October is here, and so is an update to ICD-10, effective Oct. 1. This year’s code updates affect eyecare mostly in the eyelids, brow, conjunctiva, and meibomian gland anatomic areas. Be sure your systems have the new codes uploaded and have begun using them in practice.

Here are the new codes and code changes I suspect might be commonly considered in an eyecare practice, via chapter of the 2019 CPT.

Chapter 2

The neoplasm chapter adds options for upper and lower eyelids. An example of this is:

• C43.111 Malignant melanoma of RU eyelid, incl. canthus
• C43.112 Malignant melanoma of RL eyelid, incl. canthus
• C43.121 Malignant melanoma of LU eyelid, incl. canthus
• C43.122 Malignant melanoma of LL eyelid, incl. canthus

Others in this section have similar changes; they are:

• Merkel cell (C4A.-), Basal cell (C44.11-), Squamous cell (C44.12-), and Sebaceous cell (C44.13-)
• Melanoma in situ (D03.1-) and Carcinoma in situ (D04.1-)
• Melanocytic nevi (D22.1-) and “Other benign neoplasm of skin (eyelid)” (D23.1-)

Chapter 7

The eye chapter reveals changes to the blepharitis codes different than above; they allow for both lids on one side to be selected. An example of this is:

• H01.00A Unspecified blepharitis right eye, upper and lower eyelids
• H01.00B Unspecified blepharitis left eye, upper and lower eyelids

There are similar changes to other blepharitis codes as well. Those are:

• Ulcerative blepharitis (H01.01A and H01.01B)
• Squamous blepharitis (H01.02A and H01.02B)

For lagophthalmos, there is “both lids right” and “both lids left” as well as an “all 4 lids” option. Examples are:

• H02.20A Unspecif. lagophthalmos right eye, upper and lower eyelids
• H02.20B Unspecif. lagophthalmos left eye, upper and lower eyelids
• H02.20C Unspecif. lagophthalmos, bilateral, upper and lower eyelids

Other lagophthalmos codes have the same changes:

• Cicatricial (H02.21A to H02.21C)
• Mechanical (H02.22A to H02.22C)
• Paralytic (H02.23A to H02.23C)

Paralytic ectropion is a new code; there are multiple options, although you are advised to use caution for the codes below ending in “3,” “6,” or “9” for lack of specificity reasons.

• H02.151 Paralytic ectropion of right upper eyelid
• H02.152 Paralytic ectropion of right lower eyelid
• H02.153 Paralytic ectropion of right eye, unspecified eyelid
• H02.154 Paralytic ectropion of left upper eyelid
• H02.155 Paralytic ectropion of left lower eyelid
• H02.156 Paralytic ectropion of left eye, unspecified eyelid
• H02.159 Paralytic ectropion of unspecified eye, unspecified eyelid

ICD-10 coding changes for meibomian gland dysfunction increase specificity:

• H02.88 Meibomian gland dysfunction of eyelid
  • H02.881 Meibomian gland dysfunction right upper eyelid
  • H02.882 Meibomian gland dysfunction right lower eyelid
  • H02.883 Meibomian gland dysfunction right eye, unspecified lid
  • H02.884 Meibomian gland dysfunction left upper eyelid
  • H02.885 Meibomian gland dysfunction left lower eyelid
  • H02.886 Meibomian gland dysfunction left eye, unspecified eyelid
  • H02.889 Meibomian gland dysfunction unspecified eye, unspecified eyelid
  • H02.88A Meibomian gland dysfunction right eye, upper and lower eyelids
  • H02.88B Meibomian gland dysfunction left eye, upper and lower eyelids

Other new codes in our chapter cover conjunctivitis and eyebrow. Specifically, having a “Brow Ptosis” code in ICD-10 is a particularly welcome change for oculoplastics specialists.

• H10.82 Rosacea conjunctivitis
  • Code first underlying rosacea dermatitis (L71.-)
  • H10.821 Rosacea conjunctivitis, right eye
  • H10.822 Rosacea conjunctivitis, left eye
  • H10.823 Rosacea conjunctivitis, bilateral
  • H10.829 Rosacea conjunctivitis, unspecified eye
• H57.81 Brow ptosis
  • H57.811 Brow ptosis, right
  • H57.812 Brow ptosis, left
  • H57.813 Brow ptosis, bilateral
  • H57.819 Brow ptosis, unspecified
• H57.89 Other specified disorders of eye and adnexa

Some codes in Chapter 7 have more subtle changes to the instructions or details. These codes are:

• H04.2- (epiphora) “Lacrimal gland” was changed to “side”
• H10.51 Ligneous conjunctivitis (only a “Code also” change)

Code also underlying condition if known, such as:

• plasminogen deficiency (E88.02)

Other chapters

To wrap up the changes for 2019, here are the other chapter changes:

• Chapter 12. L51 Erythema multiforme instruction: Use additional code for associated manifestations, such as: edema of eyelid (H02.84-)
• Chapter 16. P35.4 Congenital Zika virus disease: Use additional code to identify manifestations of congenital Zika virus disease.
• Chapter 19. T81 Complications of procedures, not elsewhere classified
  • T81.4 Infection following a procedure: Changed “Excludes1” (all) to an “Excludes2” (all) notation
  • T81.41 Infection following procedure, superficial incision surgical site
  • T81.42 Infection following procedure, deep incisional surgical site
  • T81.43 Infection following procedure, organ and space surgical site
  • T81.44 Sepsis following a procedure: Use additional code to identify the sepsis
  • T81.49 Infection following a procedure, other surgical site

Conclusion

When a new code exists, you must use it to greatest specificity.

As always, “good coding to you.” OP

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