ED Coding and Reimbursement Alert
Look Sharp and Listen Up: ICD-10 Brings These Changes to Your Eyes and Ears Disease Diagnoses
Exact anatomical location and laterality are the buzzwords for dealing with eye and ear presentations.
When it comes to a need for greater specificity, the eyes and ears have it in ICD-10. Read on for instruction on how this works in your ED reporting.
In ICD-10, eye codes have been expanded to increase anatomic specificity and add the concept of laterality. Many of the codes include right, left, bilateral and unspecified eye. If the option of “bilateral” is not available, and the condition is present in both eyes, it is correct to assign the code for right and left. However, if a code exists for bilateral, that should be assigned, not right and left eye, says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA Certified ICD-10 Instructor and President, Edelberg Compliance Associates.
A few common ED eye presentations can demonstrate how location and specificity determine the ICD-10 code from Chapter 7, such as:
Document Type, Location for Glaucoma
Assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, the affected eye, and the glaucoma state. »
When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage and there is a code for bilateral glaucoma, you should report only the code for glaucoma type using, bilateral with the seventh character for the stage.
However, when a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e., subcategories H40.10, H40.11 and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage, Edelberg warns.
You assign the seventh character “4” for glaucomas whose stage cannot be clinically determined. Do not confuse seventh character “0” with “4,” as “0” denotes unspecified which is assigned when there is no documentation regarding the stage of the glaucoma, Edelberg adds.
Not All Eye Problems Appear in Chapter 7
Burns to the eye (T26-T28) and corneal abrasions without foreign body (S05.0xx), corneal and conjunctival abrasions with foreign body (T15.xxx) are defined in other chapters of ICD-10. Codes from the S05.0xx categories require a 7th characters to identify initial encounter (A); subsequent encounter (D); or sequela (S).
You must document the exact location, type of injury or disease underlying disease and exact location of the area being treated. Injuries and wounds should be coded to the type of disorder injury, such as open wound of eyelid, superficial injury of eyelid or, for diseases of the ear, code first the condition followed by the code for the external cause of the condition, says Edelberg.
Use a “Block” Approach to Coding Ear, Mastoid Process Diseases
Although Chapter 8 “Diseases of the Ear and Mastoid Process” is also an entirely new chapter in ICD-10-CM, the conditions classified in this chapter are located in Chapter 6, “Diseases of the Nervous System and Sense Organs.”
Format tip: Diseases of the ear and mastoid process have been arranged into blocks making it easier to identify the types of conditions that would occur in the external ear (block 1), middle ear and mastoid (block 2), and inter ear (block 3). Block 4 is used for other disorders of the ear. Block 5 contains the codes for intraoperative and post procedural complications. The intraoperative and post procedural complications are grouped at the end of the chapter rather than scattered throughout different categories, Edelberg explains.
Other changes include greater specificity added at the fourth-, fifth-, and sixth-character levels; the delineation of laterality; and the addition of many more ‘code first underlying disease’ notes. One classification change in the chapter is that ICD-9-CM category 381 (Non suppurative otitis media and Eustachian tube disorders), has been split into two categories in ICD-10-CM;
Codes from these categories are among those you may frequently experience in the ED, says Edelberg. Such as:
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