Ophthalmology and Optometry Coding Alert

Good news for ophthalmologists treating patients with retinopathy of prematurity (ROP): Starting in October, you'll be able to code more accurately with diagnosis codes for each stage of the condition.

CMS has released its list of new ICD-9 codes for 2009, including a new series describing stages 0-5 of ROP, a disease that can lead to blindness in prematurely born infants. The new codes take effect on Oct. 1, 2008 -- prior to that, ophthalmology coders' only option is to report 362.21 (Retrolental fibroplasia), which refers to the name by which ROP used to be known.

The more detailed codes will help with early intervention in the disease by distinguishing between minor and major ROP, according to information that Patrick Romano, MD, MPH, presented to the ICD-9-CM Coordination and Maintenance Committee on behalf of the Agency for Healthcare Research and Quality.

The new ICD-9 codes, and the ROS stages they describe, are as follows:

• 362.20 (Retinopathy of prematurity, unspecified)

• 362.22 (Retinopathy of prematurity, stage 0) -- immature retina without vascular changes; no clear demarcation of vascular and avascular retina

• 362.23 (Retinopathy of prematurity, stage 1) -- mildly abnormal blood vessel growth; a flat line demarcates the vascular and avascular areas

• 362.24 (Retinopathy of prematurity, stage 2) -- moderately abnormal blood vessel growth; fibrous tissue protrudes into the vitreous between the vascular and avascular areas

• 362.25 (Retinopathy of prematurity, stage 3) -- severely abnormal blood vessel growth; new blood vessels and fibrous tissue along ridge or extending into vitreous

• 362.26 (Retinopathy of prematurity, stage 4) -- partial retinal detachment

• 362.27 (Retinopathy of prematurity, stage 5) -- total retinal detachment.

Look for: ICD-9 2009 will also introduce new codes for plateau iris syndrome (364.82), a condition ophthalmologists sometimes see in managing post-iridectomy patients, and pingueculitis (372.34), which occurs when small corneal lesions known as pinguiculae become swollen and inflamed.

In October, ophthalmologists may also see more options for coding the diabetes that underlies many ophthalmic conditions. The new diagnosis codes include a new series, 249.xx, with 20 codes describing various manifestations of secondary diabetes mellitus (diabetes that occurs as a result of another medical condition).

Before October, coders should still use 251.8 (Other specified disorders of pancreatic internal secretion) for secondary diabetes diagnoses.

Take note of these codes in the new 249.xx series:

• 249.50 -- Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified

• 249.51 -- Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled.

For patients with type I or type II diabetes, continue to report codes from the 250.5x series (Diabetes with ophthalmic manifestation), with the fifth digit corresponding to whether the diabetes is type I, type II, controlled or uncontrolled.

Coders should also look for a new diagnosis code describing acute chemical conjunctivitis. The American Academy of Pediatrics proposed the new code at the March meeting of the ICD-9-CM Coordination and Maintenance Committee. Acute chemical conjunctivitis can result when any irritating substance, like household cleaners, smoke, smog or chlorine, enters the eyes.

Currently, ICD-9 points coders to 372.01 (Serous conjunctivitis, except viral), which the AAP does not think allows for adequate monitoring of the condition. The new code, 372.06 (Acute chemical conjunctivitis), would include a note that the diagnosis excludes burns of eye and adnexa (940.0-940.9) and chemical corrosion injury of eye (940.2-940.3).

The code does not appear on the lists released by CMS but may still appear on future lists.

Learn more: To see all of the new, deleted and revised ICD-9 codes for 2009, visit http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp.