The United States is currently the only developed country in the world that is still using the outdated ICD-9-CM Volume III for diagnosis codes, electronic health records, and insurance claims. However, this is soon to change. As of October 1st 2015, the official final deadline for ICD-10 implementation, insurance companies will no longer be accepting ICD-9 for diagnosis or procedure codes. This means that all healthcare professionals must begin learning ICD-10-CM and ICD-10-PCS codes now, especially as they apply to medical specialties.
In this three-part series, we will be examining ten of the most commonly used ICD-9-CM codes for each of three distinct specialties—Dermatology, Ophthalmology, and Plastic Surgery—and comparing them to their respective ICD-10-CM counterparts.
By doing so, we will see how the high specificity level of ICD-10-CM makes it far superior to ICD-9-CM (which is loaded with obsolete, outdated terminology as well as outmoded and ambiguous codes, not to mention inadequate data that fails to accommodate for a multitude of medical discoveries and advances that have occurred in recent decades).
ICD-10-CM Codes in Ophthalmology
In Part 1 of this series, we discussed ten common ICD-9/10-CM codes that are specific to Dermatology. For this second installment, we will look at ten of the more commonly used Ophthalmology-specific codes in the soon-to-be phased out ICD-9-CM system. We will then look at how these codes can be translated into the new, more specific ICD-10-CM coding language.
RELATED: The Final Countdown: ICD-10 for Ophthalmology
Let’s begin with a fairly simple code: Vitreous hemorrhage
In ICD-9-CM, this would fall under 379.23 (379 being the general category for “Other disorders of the eye,” and .23 to denote a vitreous hemorrhage). However, this outdated code fails to specify which eye is affected. In ICD-10-CM, vitreous hemorrhage would be coded in the following manner:
Primary category: H (0-59, for diseases of the eye and adnexa)
2-digit category: 43 (disorders of the vitreous body)
So the primary code would be H43, which is then further specified (according anatomic site) to create a final diagnosis code from the following possibilities:
L43.1: Vitreous hemorrhage
L43.10: Vitreous hemorrhage, unspecified eye
L43.11: Vitreous hemorrhage, right eye
L43.12: Vitreous hemorrhage, left eye
L43.13: Vitreous hemorrhage, bilateral/both eyes
Let’s try another: Senile entropion
This is coded in ICD-9-CM as 374.11, which just tells someone that the diagnosis is senile entropion, without any further specification as to location. In the ICD-10-CM language, however, there are a number of far more specific coding options.
Primary category: H (0-59, diseases of the eye and adnexa)
2-digit category: 02 (other disorders of the eyelid)
So the primary code would be H02, and must now be specified (again, according to anatomic site) to create a final diagnosis code from the following possibilities:
H02.03: Senile entropion of eyelid
H02.031: Senile entropion of right upper eyelid
H02.032: Senile entropion of right lower eyelid
H02.033: Senile entropion of right eye, unspecified eyelid
H02.034: Senile entropion of left upper eyelid
H02.035: Senile entropion of left lower eyelid
H02.036: Senile entropion of left eye, unspecified eyelid
H02.039: Senile entropion of unspecified eye, unspecified eyelid
For our third example, let’s look at one that’s a little more complex: Diabetic cataract
This is coded in ICD-9-CM as 366.41, which is rather vague and broad, and fails to specify details such as the type of diabetes and location of the cataract. In ICD-10-CM, however, this category branches out into a number of specific coding options.
Primary category: E (0-89, for metabolic, nutritional, and metabolic diseases)
2-digit category: 08 (diabetes mellitus due to underlying condition); 09 (drug or chemical induced diabetes mellitus); 10 (Type 1 diabetes mellitus); 11 (Type 2 diabetes mellitus); or 13 (other specified diabetes mellitus).
In this case, there are several possible primary codes to choose from—E08, E09, E10, E11 or E13. The primary code as well as the specific, final diagnosis code will need to be chosen (according to factors such as etiology and other vital details) from the following possibilities:
E08.36: Diabetes mellitus due to underlying condition with diabetic cataract
E09.36: Drug or chemical induced diabetes mellitus with diabetic cataract
E10.36: Type 1 diabetes mellitus with diabetic cataract
E11.36: Type 2 diabetes mellitus with diabetic cataract
E13.36: Other specified diabetes mellitus with diabetic cataract
Our fourth example should be fairly common for anyone in Ophthalmology: Routine examination of the eyes
This is coded in ICD-9-CM as V72.0.39, identifying it only as an examination without disclosing the findings of the exam as normal/abnormal. In ICD-10-CM, on the other hand, exam findings must be specified.
Primary category: Z (0-13, for persons encountering health services for examinations)
2-digit category: 01 (encounter for special examination without complaint, suspected or reported diagnosis)
In this case, the primary code would be Z01. The specific, final diagnosis code, based on the findings of the exam, would need to be chosen from the following possibilities:
Z01.0: Encounter for examination of eyes and vision
Z01.00: Encounter for examination of eyes and vision without abnormal findings
Z01.01: Encounter for examination of eyes and vision with abnormal findings
Just to make sure you’ve got the idea, we’ll do one more step-by-step example: Gonococcal infection of the eye.
This is coded in ICD-9-CM as 098.4. Let’s see how it would be coded with ICD-10-CM.
Primary category: A (50-64, infections with a predominantly sexual mode of transmission)
2-digit category: 54 (gonococcal infection)
The primary code would be A54. The specific, final diagnosis code, based on the symptoms and situation, would be chosen from the following possibilities:
A54.3: Gonococcal infection of the eye
A54.30: Gonococcal infection of the eye, unspecified
A54.31: Gonococcal conjunctivitis
A54.32: Gonococcal iridocyclitis
A54.33: Gonococcal keratitis
A54.39: Other gonococcal eye infection
You should now have at least a general understanding of how ICD-10-CM coding works in Ophthalmology. Therefore, the last five examples have been simplified a bit. However, they still offer useful reference points for some of the more common ICD-9/10-CM codes that will be used in the Ophthalmology specialty.
ICD-9-CM Code 361.32—Horseshoe tear of retina without detachment
ICD-10-CM Possibilities:
H33.3: Retinal breaks without detachment
H33.31: Horseshoe tear of retina without detachment
H33.311: Horseshoe tear of retina without detachment, right eye
H33.312: Horseshoe tear of retina without detachment, left eye
H33.313: Horseshoe tear of retina without detachment, bilateral/both eyes
H33.319: Horseshoe tear of retina without detachment, unspecified eye
ICD-9-CM Code 365.01—Open angle with borderline findings, low risk
ICD-10-CM Possibilities:
H40.0: Glaucoma suspect
H40.01: Open angle with borderline findings, low risk
H40.011: Open angle with borderline findings, low risk, right eye
H40.012: Open angle with borderline findings, low risk, left eye
H40.013: Open angle with borderline findings, low risk, bilateral/both eyes
H40.019: Open angle with borderline findings, low risk, unspecified eye
ICD-9-CM Code 373.02—Squamous blepharitis
ICD-10-CM Possibilities:
H01.0: Blepharitis
H01.02: Squamous blepharitis
H01.021: Squamous blepharitis, right upper eyelid
H01.022: Squamous blepharitis, right lower eyelid
H01.023: Squamous blepharitis, right eye, unspecified eyelid
H01.024: Squamous blepharitis, left upper eyelid
H01.025: Squamous blepharitis, left lower eyelid
H01.026: Squamous blepharitis, left eye, unspecified eyelid
H01.029: Squamous blepharitis, unspecified eye, unspecified eyelid
ICD-9-CM Code 379.91—Pain in or around eye
ICD-10-CM Possibilities:
H57.1: Ocular pain
H57.10: Ocular pain, unspecified eye
H57.11: Ocular pain, right eye
H57.12: Ocular pain, left eye
H57.13: Ocular pain, bilateral/both eyes
ICD-9-CM Code 918.1—Cornea abrasion
ICD-10-CM Possibilities:
S05.01: Injury of conjunctiva and corneal abrasion without foreign body, right eye
S05.01XA: Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter
S05.01XD: Injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter
S05.01XS: Injury of conjunctiva and corneal abrasion without foreign body, right eye, sequela
S05.02: Injury of conjunctiva and corneal abrasion without foreign body, left eye
S05.02XA: Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter
S05.02XD: Injury of conjunctiva and corneal abrasion without foreign body, left eye, subsequent encounter
S05.02XS: Injury of conjunctiva and corneal abrasion without foreign body, left eye, sequela
Hopefully, this article has provided those of you in the Ophthalmology specialty with a firm starting point for understanding the transition from ICD-9-CM to ICD-10-CM. For those of you in Plastic Surgery, we will be getting to you soon. In the third and final installment of this blog series, we will take a look at ten of the most commonly used ICD-9/10-CM codes for Plastic Surgery professionals.
