Ophthalmology and Optometry Coding Alert

Brow ptosis, clonic facial spasm get additional specificity effective Oct. 1.

The ICD-10 Committee was generous to eye care practices this year, debuting more codes than those described in our cover story. You’ll also find additional diagnosis codes for conditions such as meibomian gland dysfunction, rosacea conjunctivitis, and post-procedural infections. Read on for the scoop.

Check out New Meibomian Gland Dysfunction Codes

You’ve never had specific codes to report meibomian gland dysfunction disorders, instead being relegated to H02.89 (Other specified disorders of eyelid), which is a non-specific code. Effective Oct. 1, you’ll have an entire new category under H02.88 (Meibomian gland dysfunction of eyelid) for these conditions. The nine codes within this category will allow you to specify the affected eye and eyelid, as well as offering you unspecified codes for situations where that information isn’t documented.

Rosacea conjunctivitis: The same is true of rosacea conjunctivitis, which is currently reported with vague code L71.9 (Rosacea, unspecified). However, the AAO suggested more specific codes “to better track and identify patients with this dermatologic and ophthalmologic condition.”

The new category (H10.82, Rosacea conjunctivitis) will include four codes describing the right eye, left eye, bilateral or unspecified eye.

Other changes include a new code that will allow you to report conditions that the physician identifies, but which do not currently have a code in the ICD-10 manual. That new code is H57.89 (Other specified disorders of eye and adnexa).

Brow ptosis: You’ll also find a new category for brow ptosis (H57.81), as well as four additional codes to reflect laterality for this condition. This new code will be increasingly important as more physicians treat drooping brows, which typically result in surgery to lift the brow. The new codes will make claims for these surgeries easier since they’ll let you more accurately tell the payer why you performed the surgery.

Facial spasm coding: Eye care practices should prepare now for new code G51.31 (Clonic hemifacial spasm, right), followed by additional codes to describe the left side, bilateral, or unspecified location. These codes (G51.31-G51.39) require the coder to assign five characters to describe the location of the spasm.

See These Post-Procedural Infection Codes

If you see patients with post-procedural infections, you’re in luck. Effective Oct. 1, you’ll find coding updates that allow additional specificity in post-procedural infection coding. Three codes are scheduled for deletion at that point: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (Infection following a procedure, subsequent encounter), and T81.4XXS (Infection following a procedure, sequela).

To replace these deleted codes, ICD-10 is going infinitely more granular. You’ll find over 20 new codes that describe more specifics of the post-procedural infection or other condition, all of which fall under the following parent codes:

• T81.40 -- Infection following a procedure, unspecified
• T81.41 -- Infection following a procedure, superficial incisional surgical site
• T81.42 -- Infection following a procedure, deep incisional surgical site
• T81.43 -- Infection following a procedure, organ and space surgical site
• T81.44 -- Sepsis following a procedure
• T81.49 -- Infection following a procedure, other surgical site

The above codes represent the primary new codes, each of which will expand out to additional characters to describe whether the encounter was initial, subsequent, or for sequela. An example from the T81.40 section follows:

• T81.40XA -- Infection following a procedure, unspecified, initial encounter
• T81.40XD -- Infection following a procedure, unspecified, subsequent encounter
• T81.40XS -- Infection following a procedure, unspecified, sequela

The additional codes in the series follow this lead, with the “A,” “D,” and “S” seventh character designations.

Check This Example

Consider the following example to see how you may encounter postsurgical infection billing:

The ophthalmologist performs cataract excision on the patient’s left eye. Several days later, the patient presents to your practice and the surgical site shows swelling, pus and inflammation. The ophthalmologist incises the surgical wound and drains fluid off of it, then prescribes an antibiotic. For this situation, you will link the I&D code to T81.41XA (Infection following a procedure, superficial incisional surgical site, initial encounter).

Resource: To access the entire list of new, revised, and deleted ICD-10 codes, visit the CMS website at www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html.