On this blog, we’ve done our best over the last nine months or so to give our readers as many resources as possible to get prepared for the switch to ICD-10 in advance. In fact, back in February I provided our readers with a three-part blog series that provided a detailed look at how some of the more commonly used ICD-9 codes in Dermatology, Ophthalmology, and Plastic Surgery would translate over to ICD-10.
For those who might be in need of a little extra help in making the ICD-10 transition, I also wrote a blog post in March about the benefits of having Nextech’s intuitive ICD-10 solution—NexCode.
Seeing as how we are so close to the transition, I figured it might be a good idea to give readers one last refresher lesson. Therefore, in this three-part series, we have been looking at five commonly used ICD-9-CM codes for each of three distinct specialties—Plastic Surgery, Dermatology, and Ophthalmology—and comparing them to their respective ICD-10-CM counterparts.
ICD-10-CM Codes in Ophthalmology
In Part 1, we discussed common ICD-9/10-CM codes specific to Plastic Surgery. In Part 2, we did the same for Dermatology. In this third and final installment part of this blog series, we will be discussing five fairly common codes specific to Ophthalmology in the soon-to-be phased out ICD-9-CM system. We will then look at how these codes should be translated into the more specific ICD-10-CM coding language.
Let’s start with something fairly common—hypermetropia
In ICD-9-CM, this would fall under 367.0 (367 being the general category for “disorders of refraction and accommodation,” and .0 to denote “hypermetropia”). In ICD-10-CM, however, your coding will need to be specific to location and would be coded in the following manner:
Primary category: H (49-52, for disorders of ocular muscles, binocular movement, accommodation and refraction)
2-digit category: 52 (hypermetropia)
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This means the primary code for this in ICD-10-CM would be H52, which must now be further specified, based on location, from the following potential options:
H52.0: hypermetropia
The above code does not specify a location, and therefore it is not yet a billable code. In order to create a billable code, it must be further specified from the following potential options based on location:
H52.00: hypermetropia, unspecified eye
H52.01: hypermetropia of the right eye
H52.02: hypermetropia of the left eye
H52.03: hypermetropia, bilateral (both eyes)
Keep in mind that H52.00 may not be considered an acceptable billable code in some circumstances. Remember, it’s always best to use whichever code is most specific to the patient’s situation in order to avoid billing/claim rejections when using ICD-10-CM.
Let’s try another one—aphakia
In ICD-9-CM, this would fall under 379.31 (379 being the umbrella category for “other disorders of the eye,” and .31 to denote “aphakia”). This is a fairly umbrella-matured code, since (as with the first example) it lacks further specification as to location. However, in ICD-10-CM, aphakia would be coded in the following manner:
Primary category: H (25-28, disorders of the lens)
2-digit category: 27 (other disorders of the lens)
This means the primary code for this in ICD-10-CM would be H27, which must now be further specified according to location in order to create a final diagnosis code:
H27.0: aphakia
The above code does not specify a location, of course, and therefore it is not yet a billable code. In order to create a billable code, it must be further specified from the following potential options based on location:
H27.00: aphakia, unspecified eye
H27.01: aphakia of the right eye
H27.02: aphakia of the left eye
H27.03: aphakia, bilateral (both eyes)
Notice that H27.00 may not be specific enough to be considered an acceptable billable code in some circumstances. Once again, the code that is most specific to the patient’s situation is always your best bet to avoid billing/claim rejections when using ICD-10-CM.
For our third example, let’s look at how to code chalazion
In ICD-9-CM, this would fall under 373.2 (373 for “inflammation of the eyelids,” and .2 to denote “chalazion”). The problem here is that this code is again lacking when it comes to specifying location. In ICD-10-CM, chalazion would be coded as follows:
Primary category: H (00-05, for disorders of the eyelid, lacrimal system and orbit)
2-digit category: 00 (hordeolum and chalazion)
This means the primary code for this in ICD-10-CM would be H00, which must now be further specified:
H00.1: chalazion
Once again, the above code does not specify a location, and therefore it is not yet a billable code. In order to create a billable code, it must be further specified from the following potential options based on location:
H00.11: chalazion of the right upper eyelid
H00.12: chalazion of the right lower eyelid
H00.13: chalazion of the right eye, unspecified eyelid
H00.14: chalazion of the left upper eyelid
H00.15: chalazion of the left lower eyelid
H00.16: chalazion of the left eye, unspecified eyelid
H00.19: chalazion, unspecified eye, unspecified eyelid
Once again, be careful when using the “unspecified” codes. Sometimes, if not appropriate to the situation, using such codes could potentially result in billing/claim rejections.
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Let’s move on to our fourth example, which is a bit more complicated—corneal foreign body
In ICD-9-CM, this would be coded as 930.0 (930 being the category for “foreign body on external eye,” and .0 to denote “corneal foreign body”). Unfortunately, this does not say much when it comes to location or encounter. In ICD-10-CM, corneal foreign body would be coded in the following manner:
Primary category: T (15-19, for effects of foreign body entering through natural orifice)
2-digit category: 15 (foreign body on external eye)
This means the primary code for this in ICD-10-CM would be T15, which must now be further specified by choosing from the following options:
T15.0: foreign body in cornea
The above code does not specify a location, of course, and therefore it is not yet a billable code. In order to create a billable code, it must be further specified from the following potential options based on location and encounter:
T15.00: foreign body in cornea, unspecified eye
T15.00XA: foreign body in cornea, unspecified eye, initial encounter
T15.00XD: foreign body in cornea, unspecified eye, subsequent encounter
T15.00XS: foreign body in cornea, unspecified eye, sequela
T15.01: foreign body in cornea, right eye
T15.01XA: foreign body in cornea, right eye, initial encounter
T15.01XD: foreign body in cornea, right eye, subsequent encounter
T15.01XS: foreign body in cornea, right eye, sequela
T15.02: foreign body in cornea, left eye
T15.02XA: foreign body in cornea, left eye, initial encounter
T15.02XD: foreign body in cornea, left eye, subsequent encounter
T15.02XS: foreign body in cornea, left eye, sequela
Now for our fifth and final step-by-step example—herpes simplex w/ dendritic keratitis
In ICD-9-CM, this be coded as 054.42 (054 being the general category for “herpes simplex,” and .42 to denote “dendritic keratitis”). In ICD-10-CM, herpes simplex with dendritic keratitis would be coded in the following manner:
Primary category: B (00-09, for viral infections characterized by skim and mucous membrane lesions)
2-digit category: 00 (herpesviral infections, herpes simplex)
This means the primary code for this in ICD-10-CM would be B00, which must now be further specified according to type and location to create a diagnosis code:
B00.5: herpesviral ocular disease
The above code is not yet a billable code. In order to create a billable code, it must be further specified from the following potential options based on location and infection type:
B00.50: herpesviral ocular disease, unspecified
B00.51: herpesviral iridocyclitis
B00.52: herpesviral keratitis (this would be your most likely match to the original ICD-9 code)
B00.53: herpesviral conjunctivitis
B00.59: other herpesviral disease of the eye
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This cannot be stressed enough—always go with the ICD-10 code that is most specific to the patient’s situation in order to avoid billing/claim rejections.
I hope this article has been helpful for those of you in the Ophthalmology specialty, giving you a bit more insight into the fast approaching final transition from ICD-9 to ICD-10. With less than two weeks left, there is no more time to waste.
Thanks for reading!
