October has come and gone, so the new year’s ICD-10-CM updates are upon us. Thankfully, the changes to 2021 diagnosis coding in eye care are fewer than in past years — and we have an entirely new ICD-10 chapter. As always, these changes begin as of October (not in January). The changes we have that began last month will still be needed on claims to properly support the services our offices supply.

New chapter

Before this year, ICD-10-CM had only 21 chapters. The new one, Chapter 22, is titled “Codes for Special Purposes.” It covers the code range U00-U85. Partially out of a desire to implement new codes for uncertain etiology conditions rapidly to track them for public health, this new chapter has two new codes for vaping-related disorder (U07.0) and COVID-19 (U07.1). There has already been a “coronavirus infection” code (B34.2) in ICD-10, but with the new code for COVID-19, there is an instruction to check if it is COVID-19 or not and code appropriately.

Eye diagnosis code changes

Next, let’s go through the chapters, beginning with the Eye diagnosis codes in Chapter 7; these codes all begin with the letter H. The good news is that codes for cataract, diabetic retinopathy, glaucoma, and macular degeneration — all common for us — remain unchanged. Only two new codes (the dash at the end means there is greater specificity, usually for laterality in that code series) are available, and that we must use. The changes are:

• Hereditary corneal dystrophies (H18.5-). All the existing codes in this area gained laterality, so there are individual codes for the right eye, the left eye, and both eyes as of Oct. 1.
• Deficient smooth pursuit eye movements (H55.8). This code has no laterality, so use it for either or both eyes without modification.
• There was a proposal in March for new codes for pseudoexfoliation of the lens in the H27 area and for Stargardt’s disease in the retina section, but those are not in the new 2021 code books, so we’ll have to wait and see.

Less common changes

Other chapters also have only small changes, and they won’t be nearly as common. Those most likely to be seen in an eye practice are:

• Sickle-cell (D57.-). There is a lot more specificity in 2021.
• Headache (R51.-). This was formerly just a 3-character code but it now has greater specificity.
• Corneal transplant (T86.84-). This whole code set gained a 7th character for laterality.
• Encounter for observation for suspected inserted (injected) foreign body ruled out (Z03.82-). This code group is new and has laterality as well.
• Allergy status (Z88.-). Minor changes to wording.

There are two new codes in Chapter 20 for adverse incidents with contact lenses (Y77.11) and adverse incidents with other ophthalmic devices (Y77.19), but codes in this chapter are rarely required on claims except for some Medicaid insurances.

New guidance

Sometimes we get new guidance on how to use the codes. One such change is for those of you who have payers who insist you use the insulin and diabetic drug codes on claims. Here is the quote from the guidelines on this: “If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long-term (current) use of insulin, and Z79.899, Other long-term (current) drug therapy. If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long-term (current) use of oral hypoglycemic drugs, and Z79.899, Other long-term (current) drug therapy.”

Conclusion

If you have not accessed or purchased a 2021 book, you can still access the new ICD-10-CM codes and changes at cms.gov/medicare/icd-10/2021-icd-10-cm . The entire 2021 files are found in the ZIP folders at the bottom of this page. Lastly, I urge all of you to be safe out there. And, as always, good coding to you! OP