Ophthalmology and Optometry Coding Alert

New diagnosis codes include stages of post-trabeculectomy inflammations -- and a new code for ONH

When a patient presents with a post-op bleb infection, the current ICD-9 index guides you to 997.99 (Complications affecting other specified body systems, not elsewhere classified; other). Starting in October, however, you'll be able to code the condition -- and the level of severity  -- much more precisely.
 
Medicare has released 204 new ICD codes that should appear in your 2007 ICD-9 coding manual. Among them are four new blebitis codes that the American Academy of Ophthalmology asked for at the ICD-9 CM Coordination and Maintenance Committee meeting in September 2005.
 
Coders should use the 2007 ICD-9 codes for services rendered starting Oct. 1, 2006, says Rita Knapp, CPC, chief compliance officer and senior billing specialist at Abrams Eyecare Associates in Indianapolis.
 
Bleb infections occur up to three years after a patient has had a surgical trabeculectomy to alleviate glaucoma. Treatments may include topical drugs and repeated antibiotic injections. The four new codes describe progressive stages of the inflammation:
 
• 379.60 -- Inflammation (infection) of postprocedural bleb, unspecified

 • 379.61 -- Inflammation (infection) of postprocedural bleb, stage 1

 • 379.62 -- Inflammation (infection) of postprocedural bleb, stage 2
 
• 379.63 -- Inflammation (infection) of postprocedural bleb, stage 3.

 If you are unfamiliar with the stages of severity, the AAO describes them as follows:
 
• Stage 1: Bleb purulence with or without a mild anterior segment inflammation
 
• Stage 2: Bleb purulence and moderate anterior segment inflammation
 
• Stage 3: Marked anterior chamber reaction, vitritis, and severe pain; may lead to bleb-related endophthalmitis and acute visual loss.

The AAO also asked that the new manual include a note that states, "Excludes: bleb associated endophthalmitis (379.63)" after codes 360.0x (Prurulent endophthalmitis), 360.1x (Other endophthalmitis) and 998.5x (Other complications of procedures, not elsewhere classified; postoperative infection).

Expect New Code for Optic Nerve Hypoplasia

There's more: Ophthalmologists treating newborns with congenital vision problems will find a new ICD-9 code in 2007: 377.43 (Optic nerve hypoplasia). There is now no specific code for ONH (underdevelopment of a child's optic nerve during pregnancy). The AAO has asked that the note "Excludes: optic disc hypoplasia (377.25)" appear after 743.8 (Congenital anomalies of eye; other specified anomalies of eye) in 2007.

Most carriers have specified that ICD-9 codes 743.57 (Congenital anomalies of posterior segment; specified anomalies of optic disc) or 743.58 (... vascular anomalies) be reported for ONH now, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla.

You can download all of the new ICD-9 codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/Downloads/new_diagnosis_codes_2006.pdf. View lists of revised and invalid codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp.