Ophthalmology and Optometry Coding Alert

ICD-10 makes over 400 changes effective this fall.

When ICD-10 initially went into effect, many medical practices discussed the massive breadth of codes that went into it. However, the thickness of the manual didn’t mean that the codes within it were exhaustive. In reality, some ophthalmology coders have lamented the fact that certain conditions weren’t covered with diagnosis codes. Fortunately, CMS is expanding your options effective Oct. 1, thanks to almost 400 changes and updates to the ICD-10-CM code list.

The agency published the full listing of codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to ophthalmology and optometry practices, which were somewhat extensive this year.

Focus on New Eye Fracture Codes

When your ophthalmologist treats traumatic eye injuries, you’re limited to the codes from the S02.3x (Fracture of orbital floor) section of the ICD-10 manual. However, the orbit includes a much more complicated structure than the orbital floor, and that catch-call code does not cover every condition your provider might see.

Therefore, the American Academy of Ophthalmology requested codes to describe fractures of the orbital roof, medial wall, and temporal wall. Consequently, the latest edition of ICD-10 will include over 70 new codes to describe these conditions.

For example, 20 codes will debut under the new subcategory S02.12 (Fracture of orbital roof), as well as over 40 new options to describe the specific site of an orbital wall fracture (S02.83 to S02.84), and seven codes to describe “fracture of orbit, unspecified” (S02.85).

The codes are separated out to describe whether the affected eye was on the left or ride side, and some expand further to indicate whether the fracture was open or closed. In addition, you’ll use an additional character to explain whether the fracture had routine healing, delayed healing, or nonunion.

Although the expanded code options are welcome by eye care practices, the coding additions may require clinicians to be much more specific in their documentation so you can select the correct code. If factors such as sequela, laterality, or fracture status are missing from the record, you’ll struggle to find the accurate ICD-10 option.

Check New Vision Screening Codes

ICD-10 also introduced separate codes in the Z01.0 (Encounter for examination of eyes and vision) category, and practices will need to be certain to add these codes, as they are different from the existing Z01.00 (Encounter for examination of eyes and vision without abnormal findings) and Z01.01 (… with abnormal findings) codes.

Now, you will be able to document a failed vision screening without abnormal findings (Z01.020) and with abnormal finding (Z01.021). “These new six-digit codes state that the encounter was specifically for failed vision screenings, with or without abnormal findings. These will be very important to use correctly,” says Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. “The codes will also help justify the need for further vision or hearing testing, which could be very important especially if a vision or hearing test was performed during that same year in a well care visit,” Holle adds.

The change brings the vision codes in line with the Z01.1 (Encounter for examination of ears and hearing) codes. And, like the existing vision codes, there is a note that tells you to use an additional code to specify what the abnormal findings are if you do report Z01.021.

Resource: To check out the complete list of new ICD-10 codes, visit the CMS website at  www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.