ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com

ICD-10 Coding for Contact Lens
Problems
The EyeCodingForum.com
Jeffrey Restuccio, CPC, CPC-H, MBA
Memphis TN
(901) 517-1705
[email protected]
www.EyeCodingForum.com
EyeCodingForum.com
1
Coding for Contact Lens Complications
• Many common conditions/diseases are not listed in the
current ICD-9 manual. How will they translate to ICD-10? Will
it correct all the omissions and incorrect descriptions
currently found in ICD-9?
• For the most part, no.
• Yes, Dry Eye Syndrome will now be part of the ICD-10 code
description.
H04.121
Dry eye syndrome of right lacrimal gland
• But many will continue to retain international descriptions
that are different from common terms used in the United
States.
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Top Five Contact Code Problem ICD-9
Codes/Conditions
• ICD-9 and Description
ICD-9
368.8
379.91
379.93
375.15
368.2
Description
Blurred Vision
Eye Pain
Redness of Eyes
Dry Eyes
Double Vision/diplopia
This list includes about 80% of visits for contact lens-related
problems.
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ICD-10 Crosswalk
• Note separate diplopia and double vision codes.
Other specified disorders of eye and adnexa [blurred
1) H57.8
vision crosswalk]
2) H57.13 Ocular pain, bilateral [four codes]
3) H57.8
Other specified disorders of eye and adnexa [redness]
4) H04.121 Dry eye syndrome of right lacrimal gland [four codes]
5) H53.2
Diplopia [ICD-9 crosswalk to 368.2]
Other subjective visual disturbances [Includes:
H53.19 Double vision; ICD-9 crosswalk: 368.15]
368.15: Subjective visual disturbances: other visual distortions and
entoptic (visual effects whose source is within the eye itself)
phenomena
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Common Coding Errors
371.82
375.15
Corneal Disorder due to Contact Lens
Corneal Edema due to Wearing of Contact Lens [this is
an error per ICD-9]
• The two codes are recommended above but 375.15 is clearly
incorrect per ICD-9 guidelines.
371.15
371.82
Corneal pigmentations and deposits: other deposits
associated with metabolic disorders [actual ICD-9
description]
Other corneal disorders: corneal disorder due to
contact lens
Excludes corneal edema due to contact lens (371.24)
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Correct Contact ICD-10 Codes
• Correct ICD-9 code
371.24
Corneal edema: corneal edema due to wearing of
contact lenses
H18.219
Corneal edema secondary to contact lens,
unspecified eye
371.82
Corneal Disorder due to Contact Lens
H18.829
Corneal disorder due to contact lens, unspecified eye
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Other conditions
• How does one code for: more serious
conditions like corneal hypoxia, infiltrates, and
microbial keratitis?
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Terms and definitions
• SEAL: Superior Epithelial Arcuate Lesion: It is a white lesion in the
superior cornea that can be up to 0.5 mm wide and from 1 mm to 5
mm long.
• CLARE: Contact Lens-induced Acute Red Eye: A sudden onset of a
corneal infiltrative event observed during extended wear of
hydrogel contact lenses that is always associated with sleep.
Patients report waking up with irritation or pain, redness and
watery eyes. Sometimes, these symptoms are not noticed until
soon after waking (HPI: timing).
• CLPU: Contact Lens-induced Peripheral Ulcer: A circular, wellcircumscribed, dense, yellowish-white, focal corneal infiltrate (0.2
mm to 2.0 mm in diameter) located in the peripheral to midperipheral cornea. It is always located in the anterior stroma and
has a complete loss of overlying epithelium. Symptoms can vary but
may include pain or soreness, irritation and watering.
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Terms and definitions
• Microcysts: Small (15 μm to 50 μm), irregularly shaped
inclusions, typically found in the paracentral to mid-peripheral
zones of the cornea, best observed with retro-illumination.
These show reversed illumination due to a suspected higher
refractive index than the surrounding tissue.
• Often clear and asymptomatic. Report the underlying
symptoms:
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Terms and definitions
• MK — Microbial Keratitis: occurs as a result of an infection of
the cornea by replicating microbes (bacterial, viral, fungal or
amoebae). In contact lens wear, it is usually preceded by
hypoxia and/or an epithelial break. Contact lens wearers, in
particularly extended wear, are more prone to develop MK.
The most common bacteria associated with contact lensrelated MK is Pseudomonas aeruginosa.
• Bacteria tend to bind to the back surface of silicone hydrogel
lenses after patients have been swimming. Always
recommend that patients remove and disinfect their lenses
after any exposure to pools, lakes or rivers.
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Top MK Symptoms ICD-9 Codes
• Top codes
1
2
3
4
4
5
370.03 Corneal Ulcer, Central
364.03 Secondary Iridocyclitis, Infectious
Unspecified disorder of eye and adnexa: pain in or
379.91 around eye [eye pain]
Other specified disorders of eye and adnexa [
379.93 redness of Eyes]
375.21 Epiphora
368.13 Photophobia
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Top MK Symptoms ICD-9 Codes
• ICD-10 crosswalk. Not always exact.
1
2
3
4
5
H16.011 Corneal Ulcer, Central
Secondary Iridocyclitis, Infectious
Secondary infectious iridocyclitis, right eye [also
H20.031 noninfectious, H20.041]
H57.13 Ocular pain, bilateral
H57.8
Redness of Eyes [no eye code]
H04.201 Unspecified epiphora, right lacrimal gland
Epiphora due to excess lacrimation, right
H04.211 lacrimal gland
Epiphora due to insufficient drainage, right
H04.221 lacrimal gland
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Top MK Symptoms ICD-9 Codes
• ICD-10 crosswalk. Not always exact.
6
H53.149 Photophobia
Visual discomfort, right eye [Includes:
Metamorphopsia; photophobia term not in
H53.149 ICD-10]
• Only report those codes documented, relevant to this
encounter, and sufficient to support medical necessity for a
given procedure or office visit.
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Other Complications
• Exposure keratitis is not found in the ICD-9 manual.
It is listed as: exposure keratoconjunctivitis
• It is an incomplete closure of the eyelid causing a dry,
inflamed eye.
Certain types of keratoconjunctivitis: exposure
370.34 keratoconjunctivitis
H16.219 Exposure keratoconjunctivitis, unspecified eye
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Exposure keratoconjunctivitis
• All codes; Note codes are not by eyelid.
H16.211 Exposure keratoconjunctivitis, right eye
H16.212 Exposure keratoconjunctivitis, left eye
H16.213 Exposure keratoconjunctivitis, bilateral
H16.219 Exposure keratoconjunctivitis, unspecified eye
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Keratoconjunctivis sicca
• Keratoconjunctivitis sicca has two options in ICD-9.
• The condition involves reporting biomicroscopic findings
without referring to the underlying cause.
710.2 Diffuse diseases of connective tissue: sicca syndrome
Keratoconjunctivitis sicca
Sjogren's disease [Sjögren's syndrome]
Certain types of keratoconjunctivitis:
keratoconjunctivitis sicca, not specified as Sjogren's [dry
370.33 eyes]
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Remember, International Definitions
• Keratoconjunctivitis sicca (KCS), (aka keratitis sicca,
xerophthalmia or dry eye syndrome, is an eye disease caused
by eye dryness it is caused by either decreased tear
production or increased tear-film evaporation.
H16.221
H16.222
H16.223
H16.229
Keratoconjunctivitis sicca, not specified as Sjögren's,
right eye
Keratoconjunctivitis sicca, not specified as Sjögren's,
left eye
Keratoconjunctivitis sicca, not specified as Sjögren's,
bilateral
Keratoconjunctivitis sicca, not specified as Sjögren's,
unspecified eye
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Dry Eye Syndrome
• Use the following ICD-10 code for DES
H04.121
H04.122
H04.123
H04.129
Dry eye syndrome of right lacrimal gland
Dry eye syndrome of left lacrimal gland
Dry eye syndrome of bilateral lacrimal glands
Dry eye syndrome of unspecified lacrimal gland
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Sicca Syndrome ICD-10
• GEMS Crosswalk of ICD-9: 710.2
• Listed also as Sjögren's syndrome: a systemic autoimmune
disease in which immune cells attack and destroy the exocrine
glands, which produce tears and saliva. Unless it was
diagnosed separately, M35.01 would be the correct code.
ICD-10
Description
M35.00 Sicca syndrome, unspecified
M35.01 Sicca syndrome with keratoconjunctivitis
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More Terms
• CLPC : Contact Lens-induced Papillary Conjunctivitis (Aka Giant
Papillary Conjunctivitis [GPC]): Symptoms may range from mild
hyperemia of the upper tarsal conjunctiva with a few, small papillae
to severe hyperemia with large, raised papillae, which have a
cobblestone appearance. CLPC may present as a localized or
generalized response. Symptoms include itching and a stringy or
ropy mucous discharge. Excessive lens movement or decentration
and blurred vision may also occur. Lens material, design or fitting
characteristics may need to be modified to prevent recurrence of
this condition. Etiologies for CLPC include: mechanical abrasion
from poor edge design and protein film abrasiveness.
• A code does exist, but it's not called GPC. It all depends on the
etiology. Since papillae aren't follicles, we can't use the code for
follicular conjunctivitis.
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Incorrect Coding
• Some Eyecare coding consultants recommend code 372.10,
chronic conjunctivitis, unspecified, for an allergic underlying
cause. Again, there are additional codes:
Chronic conjunctivitis: other chronic allergic
372.14 conjunctivitis
H10.401
H10.411
H10.421
H10.431
Unspecified chronic conjunctivitis, right eye
Chronic giant papillary conjunctivitis, right eye
Simple chronic conjunctivitis, right eye
Chronic follicular conjunctivitis, right eye
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More Dx
• Ulcers of the eye; note by eye.
H16.001
H16.011
H16.021
H16.031
H16.041
H16.051
H16.061
H16.071
Unspecified corneal ulcer, right eye
Central corneal ulcer, right eye
Ring corneal ulcer, right eye
Corneal ulcer with hypopyon, right eye
Marginal corneal ulcer, right eye
Mooren's corneal ulcer, right eye
Mycotic corneal ulcer, right eye
Perforated corneal ulcer, right eye
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Other Complications
• More codes
ICD-9
ICD-10
370.6
H16.401
Description
Corneal Neovascularization
370.64
Corneal Ghost Vessels
H16.419
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Sample CMS-1500 Form
Use for
codes,
co-management
and unique
situations
Use
forunlisted
unlisted
codes,
co-management
and unique
situations
377.00 Papilledema
714.0 Rheumatoid arthritis
V58.69 High Risk Med - Plaquenil
077.3 Other adenoviral conjunctivitis
03/1/2010
11
92225
03/1/2010
11
92014
2,3
03/1/2010
11
87809
4
-RT
1
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Crosslinks
• ICD-10 codes
ICD-9
ICD-10
Description
377.00
H47.10
Papilledema [unspecified]
V58.69
Z79.899
High Risk Med - Plaquenil
714.0
M06.9
Rheumatoid arthritis
077.3
B30.1
Other adenoviral conjunctivitis
• Is this correct?
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Not exactly
• There’s always more. These are the ICD-10 descriptions.
377.00
H47.10 Unspecified papilledema
V58.69
Z79.899 Other long term (current) drug therapy
714.0
M06.9 Rheumatoid arthritis, unspecified
077.3
B30.1 Conjunctivitis due to adenovirus
• The ICD-10 codes must be reviewed individually—now before the
implementation date; otherwise you will be substituting old
unspecific codes for new unspecific codes—that may be inaccurate
and cause a denial.
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Papilledema codes
• More papilledema codes.
H47.10
H47.11
H47.12
H47.13
Unspecified papilledema
Papilledema associated with increased intracranial
pressure
Papilledema associated with decreased ocular pressure
Papilledema associated with retinal disorder
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Rheumatoid arthritis
• Rheumatoid arthritis
M06.00
Rheumatoid arthritis without rheumatoid factor,
unspecified site [More 6th digit site codes]
M06.80
Other specified rheumatoid arthritis, unspecified
site
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Adenovirus
B30.0
B30.1
B30.2
B30.3
B30.8
B30.9
Keratoconjunctivitis due to adenovirus
Conjunctivitis due to adenovirus [crosswalk]
Viral pharyngoconjunctivitis
Acute epidemic hemorrhagic conjunctivitis
(enteroviral)
Other viral conjunctivitis
Viral conjunctivitis, unspecified
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The Bottom Line
• While many codes have a clean crosswalk most problems are
crosswalking an unspecific ICD-9 code to an unspecific ICD-10
code.
• The ICD-10 codes must be reviewed early to determine which
are relevant and which are not.
• Most won’t even know the correct questions to ask. I will help
you ask the right questions.
• That is the goal of the complete ICD-10 training course and
additional webinars we will be conducting throughout 2014.
• Many carriers will not have representatives knowledgeable
about Eyecare. It will be a challenge determining which codes
they require after the October 1 2014 implementation date.
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Questions?
• If you order the complete ICD-10 training course
($225) or the $299 bundle after purchasing this
50-minute Webinar for $49, contact
[email protected] for a rebate code.
• The EyeCodingForum is your one-stop source for
all ICD-10 coding updates.
• In addition, we will continue to have monthly
webinars on coding, billing, documentation and
compliance topics relevant to Eyecare (both
Optometrists and Ophthalmologists).
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Thank you for listening to the
EyeCodingForum’s
ICD-10 Coding for Contact Lens
Problems
Jeffrey Restuccio, CPC, CPC-H, MBA
Memphis TN
(901) 517-1705
[email protected]
www.EyeCodingForum.com
EyeCodingForum.com
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