ICD 10 Coding Alert

Eyelid cancer, brow ptosis are also diagnosis codes to watch.

Blepharitis coding could be set for a pretty big overhaul as part of the Oct. 1, 2017, ICD-10 update. That’s the word from the proposed changes that the ICD-10 Coordination and Maintenance Committee discussed during its March meeting.

The Committee will not make final decisions until later this year, but the following proposals are on the table and could impact ophthalmology practices nationwide if they are approved.

Focus on Blepharitis Expansion

The proposal includes codes that would allow additional specificity in blepharitis coding. If confirmed, the new codes would let you report just one code when more than one eyelid is affected with blepharitis. The changes, proposed by the American Academy of Ophthalmology (AAO), include six new codes in the H01.0 (Blepharitis) range.

For instance: The proposed changes would expand the current blepharitis codes and include letters in addition to the current coding convention of numbers, adding the following new codes:

• H01.00A —  Unspecified blepharitis right eye, both eyelids
• H01.00B — Unspecified blepharitis left eye, both eyelids
• H01.01A — Ulcerative blepharitis right eye, both eyelids
• H01.01B — Ulcerative blepharitis left eye, both eyelids
• H01.02A — Squamous blepharitis right eye, both eyelids
• H01.02B — Squamous blepharitis left eye, both eyelids

If the ICD-10 Committee approves the new codes, ophthalmology practices will be able to report just one code when the patient has blepharitis on both lids of the same eye.

Follow the Proposed Changes to Eyelid Cancer

Because ophthalmologists and optometrists are often the first clinicians to discover eyelid cancer, it’s important for them to identify the condition using diagnosis codes. The AAO proposed 23 new categories in the eyelid cancer range, along with dozens of new codes that describe laterality to identify which eye was affected.

For example, the following are among the many new codes proposed in this category:

• New subcategory: C43.11 — Malignant melanoma right eyelid, including canthus

               o New code: C43.111 — Malignant melanoma of right upper eyelid, including canthus
               o New code: C43.112 — Malignant melanoma of right lower eyelid, including canthus

Similarly, the proposal includes corresponding codes (C43.121-C43.122) to describe the same conditions affecting the left upper and lower eyelids. The proposed new codes then continue throughout the eyelid cancer section of ICD-10, with new subcategories proposed for conditions such as basal cell carcinoma of the eyelid (C44.11), squamous cell carcinoma (C44.12) and so on throughout the category.

If finalized, these codes would typically expand out to six or seven characters to describe the eyelid details, including upper or lower as well as right or left. In the event that the codes become live in October, it would be imperative for ophthalmologists to clearly document the location of the affected eye and for coders to assign the corresponding code to reflect that condition.

“I firmly believe that a code that is carried out to its greatest specificity eliminates the need for guesswork,” says Susan Stovall, COC, CPC, AAS, medical billing and coding instructor with the Southwest Skill Center in Avondale, Ariz. “This is one of the necessary traits of a coder — being very detail-oriented and precise,” she adds. “Once we can get all of the providers to be precise in their documentation, things will get even easier. ICD-10 has solved so many issues thus far, and as it evolves with greater specificity, coders’ lives should be easier and less stressful.”

Thyroid Eye Disease, Hemifacial Spams Could Get New Codes

When treating patients with thyroid eye disease, eye care specialists have been relegated to using codes from the thyrotoxicosis and exophthalmos series’, but if the AAO’s proposed codes are finalized, you’ll have better options. The proposal includes a new subcategory (H05.27, Exophthalmos associated with thyroid disease) that includes four codes within it to describe the affected eye.

In the conjunctivitis category, the AAO suggested a new subcategory under “Other Conjunctivitis” to describe rosacea conjunctivitis (H10.82), which includes four codes that expand out to six characters to describe the affected eye.

Eye care professionals who treat hemifacial spasms may be pleased to see that the AAO proposed adding new codes with laterality distinctions for hemifacial spasms. Under the G51 (Facial nerve disorders) category, a new subcategory may debut with G51.3 (Clonic hemifacial spasm), followed by four proposed new codes to describe the right side, left side, bilateral, or unspecified side. These codes (G51.31-G51.39) would require the coder to assign five characters.

If these codes are expanded as such, you’ll need to pay careful attention to the documentation so you can assign the accurate ICD-10 codes, says Rose B. Moore, CMC, CMCO, CMIS, CMOM, CCP, PCS, CEC, CMA-ophth, president and CEO of Medical Consultant Concepts, LLC.

“Lack of specificity would create a delay or denial of claims by making the codes invalid,” Moore says. “As we continue to move towards severity of illness measures for the payment of claims, we have to look for our codes to cover these conditions.”

Potential Updates to Brow Ptosis, Orbital Bone Fractures Abound

Other proposed changes include a new subcategory (H57.8, Other specified disorders of eye and adnexa) and new codes in that grouping that describe brow ptosis (H57.81) and other specified disorders of the eye and adnexa (H57.89). In addition, the AAO has proposed new codes to describe lagophthalmos (H02.2) which would help coders identify which type of lagophthalmos (such as cicatricial or mechanical) the patient has, and the affected eye.

The AAO and the American Optometric Association also suggested new codes for meibomian gland dysfunction, which would be placed in the H02.88 series (Meibomian gland dysfunction of eyelid) and would include seven codes that specify the eyelid and the eye affected.

And because only one code exists for orbital bone fractures, the AAO proposed adding several new codes for these conditions, such as three codes under the new subcategory S02.12 (Fracture of orbital roof), as well as nine codes to describe the specific site of an orbital wall fracture and a code to describe “fracture of orbit, unspecified” (S02.B).

Finally, coders who have struggled to find an appropriate code for paralytic ectropion, currently reported with the paralytic lagophthalmos (H02.23) series, will be pleased to find that the AAO has suggested adding an entire new subcategory for paralytic ectropion of eyelid (H02.15) which includes seven codes that describe location and laterality of the affected eyelid.

Resources: These proposals were discussed at the ICD-10 Coordination and Maintenance Committee Meeting March 7-8, 2017. You can review the proposals at https://www.cdc.gov/nchs/data/icd/topic-packet_03_07_17.pdf.