Ophthalmology and Optometry Coding Alert

Plus: You’ll find revised code for Sjogren syndrome with keratoconjunctivitis.

If your patients are having residual symptoms from dealing with “long COVID,” you’ll soon have a new way to report this condition.

Here’s why: The Centers for Disease Control and Prevention (CDC) has released 191 new codes that will join the ICD-10-CM code set beginning on Oct. 1, 2021 — but that’s not all. The agency also revised and deleted some diagnosis codes, in addition to creating new guidelines for them. To get a handle on the changes most relevant to eye care practices, read on.

Check This Revision

The first update to the ICD-10-CM code set involves a revision rather than a new code. You’ll find that the descriptor for M35.01 will change from the current listing (Sicca syndrome with keratoconjunctivitis) to a new descriptor: Sjogren syndrome with keratoconjunctivitis. This will likely make your coding choices more streamlined, since most physicians use the term “Sjogren syndrome” rather than referring to “Sicca syndrome.”

COVID-19 Updates Continue

One major update to the ICD-10-CM code set includes a number of code changes related to COVID-19. “We now have the ability to code for the problems our patients are experiencing as a result of ‘long COVID,’” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey.

“All of them are related to a new special purposes code, U09.9 [Post COVID-19 condition, unspecified], which has its own notes and Code First instructions that are also new,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. The changes include:

• Notes for new code U09.9 that explain the code “enables establishment of a link with COVID-19.” The notes go on to tell you that the code is to be used to document “post-acute sequela of COVID-19,” and not for “cases that are still presenting with active COVID-19,” though it can be used for “cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19.”
• Code first instructions for U09.9 that tell you to code conditions related to COVID-19 “such as chronic respiratory failure (J96.1-), loss of smell (R43.8), loss of taste (R43.8), multisystem inflammatory syndrome (M35.81), pulmonary embolism (I26.-), and pulmonary fibrosis (J84.10).”
• A new Excludes2 note under B94.9 (Sequelae of unspecified infectious and parasitic disease) that allows you to code U09.9 in addition, if applicable.
• A change in the note under M35.81(Multisystem inflammatory syndrome) that tells you to no longer use sequelae of COVID-19 (B94.8) but to use U09.9 if the condition is a result of COVID-19.
• And a new note under Z86.16 (Personal history of COVID-19) that tells you U09.9 is now an Excludes1 code.

New ‘Z’ Codes Allow for More Clarity

You’ll find many of the newly-debuted codes are located in Chapter 21: Factors influencing health status and contact with health services. Among them are numerous codes that will enable you to document social determinants of health (SDoH) — the way social circumstances affect a patient’s health — in much greater detail. “Keep in mind that SDoH codes, when applicable, bring the patient’s medical decision making (MDM) risk up to moderate, so it is important to document these factors and incorporate them into the note,” Cobuzzi notes.

But they’re not the only changes you’ll find in that chapter. Here’s what to expect from next year’s ICD-10.

Social Determinants of Health (1): Housing Insecurity

In its continuing efforts to facilitate documentation of SDoH, the Centers for Disease Control and Prevention (CDC) has added a number of new codes to the existing Z59.- (Problems related to housing and economic circumstances) codes.

Code Z59.0 (Homelessness) is now broken out to three codes:

• Z59.00 (Homelessness unspecified)
• Z59.01 (Sheltered homelessness), which the code’s synonyms tell you to use when a patient is “living in a shelter such as: motel, scattered site housing, temporary or transitional living situation” and
• Z59.02 (Unsheltered homelessness), which you will use for patients “residing in [a] place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk” or “residing on the street.”

Additionally, “the CDC has broken out Z59.8 (Other problems related to housing and economic circumstances) into a number of new codes. You will now be able to document when a patient’s health is affected by housing instability, but the patient is currently not homeless, by adding sixth characters to Z59.81- (Housing instability, housed),” Moore adds.

So, you will now be able to report:

• Z59.811 (Housing instability, housed, with risk of homelessness)
• Z59.812 (Housing instability, housed, homelessness in past 12 months)
• Z59.819 (Housing instability, housed unspecified)

Synonyms for all the Z59.81- codes tell you that you can use them when a patient is dealing with problems due to a foreclosure on home loan, is past due on rent or mortgage, and/or has undergone unwanted multiple moves in the last 12 months. Confusingly, the CDC moved similar synonyms (“foreclosure on loan,” “isolated dwelling,” and “problems with creditors,”) that were originally assigned to what is now parent code Z59.8- to new code Z59.89 (Other problems related to housing and economic circumstances).

Social Determinants of Health (2): Food Insecurity

You also now have two codes to address health determinants based on lack of, or lack of access to, food: Z59.41 (Food insecurity) (defined as occurring when “food intake of household members is reduced and their normal eating patterns are disrupted because the household lacks money and other resources for food,” according to the U.S. Department of Agriculture (Source: www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx)) and Z59.48 (Other specified lack of adequate food), which is accompanied by the synonyms “inadequate food” and “lack of food.”

For the Z59.4- codes, Excludes1 codes for effects of hunger (T73.0), inappropriate diet or eating habits (Z72.4), and malnutrition (E40-E46) will now become Excludes2 codes, with deprivation of food (T73.0) added to the list.

Additionally, “parent code Z59.4 gets a name change from ‘Lack of adequate food and safe drinking water’ to ‘Lack of adequate food’ with the synonym ‘Inadequate drinking water supply’ deleted. But to address that issue, you’ll have a new code, Z58.6 [Inadequate drinking-water supply], which is accompanied by the synonym ‘Lack of safe drinking water,’” Moore notes.

Immunization Counseling

Lastly, one new code that will probably get an immediate workout at most medical practices this year is Z71.85 (Encounter for immunization safety counseling). The ICD-10 code will pair with immunization administration service codes, including the numerous new COVID-19 vaccine administration codes, when your provider offers education regarding the safety of a particular vaccine. It may also be appropriate in some situations where vaccine counseling occurs, but no vaccine is administered, such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …).

The code comes with Code also instructions to code an encounter for immunization (Z23) or immunization not carried out (Z28.-) as applicable, along with an Excludes1 note that you should use the encounter for health counseling related to travel (Z71.84) code instead if your provider’s immunization safety counseling is travel-related.

For the full list of added, revised, and deleted ICD-10 codes for 2022, go to www.cdc.gov/nchs/icd/icd10cm.htm, click on the ICD-10-CM FY 2022 Addenda PDF 2022 link, and download the Table and Index zip file.