Ophthalmology and Optometry Coding Alert

Get more specific thanks to new laterality changes.

If you’ve been following the annual ICD-10 code revisions over the past few years, you’ve noticed a steady transition toward more laterality than ever in eye care coding. This year is no different, as ophthalmology and optometry practices will have to update their coding systems to accommodate dozens of new codes that allow you to describe which eye was affected when corneal conditions are addressed.

Background: On July 1, CMS released the new ICD-10-CM codes and descriptors, with a total of 490 additions, 58 code deletions, and 47 revisions that will go into effect on October 1. Although there aren’t hundreds of code changes impacting eye care practices this year, the ones that are debuting will allow you to get much more specific on your claims.

Check Big Changes to the H18.5 Range

Some of the changes to the 2021 code set are the result of stakeholder requests made at last year’s ICD-10-CM Coordination and Maintenance Committee (ICMC) Meeting, during which the ICMC’s Shannon McConnell-Lamptey offered some insight into the following new code additions:

You’ll find a dramatic expansion of the codes in the H18.5 (Hereditary corneal dystrophies) code range, giving you a sixth character to report, based on laterality. For example, H18.51 (Endothelial corneal dystrophy) now expands out to four additional options, as follows:

• H18.511 (… right eye)
• H18.512 (… left eye)
• H18.513 (… bilateral)
• H18.519 (… unspecified eye)

The same is true for the other codes in the H18.5 category, which all now require coders to assign a code that reflects which eye was affected.

You’ll also find laterality codes added to the corneal transplant series (T86.84, Complications of corneal transplant). Every code in this range will now have four additional options added to reflect which eye was affected. For instance, under “Corneal transplant infection” (T86.842), you’ll now find the following four options:

• T86.8421 (… right eye)
• T86.8422 (… left eye)
• T86.8423 (… bilateral)
• T86.8429 (… unspecified eye)

The remainder of the codes in this series are also subject to the new numbering conventions, so be sure your provider specifies which eye was affected in all documentation.

“While the dystrophies are generally thought to be bilateral conditions, they may be asymmetric and may not require the same interventions,” McConnell- Lamptey said when the new codes were proposed. “Thus, laterality would improve the value of the ICD-10-CM code set for tracking outcomes. In addition, complications from a corneal transplant would most often apply to a unique eye. This should be coded properly using the correct eye laterality to assist in outcomes and quality assessments. The American Academy of Ophthalmology is requesting the following tabular changes in order to capture these conditions.”

Check Updates to H55.8 Code Listings

Eye care coders will also get a revision to code H55.81 (Saccadic eye movements), the descriptor for which will now be “Deficient saccadic eye movements.” This new specificity paves the way for a new code to debut under H55.82 (Deficient smooth pursuit eye movements).

This new code will allow practices to differentiate between truly saccadic eye movements and those that aren’t completely smooth but haven’t been designated as saccadic.

Resource: To read the entire new ICD-10 code set, visit the CMS website at https://www.cms.gov/medicare/icd-10/2021-icd-10-cm.