Ophthalmology and Optometry Coding Alert

No other specialty has as many new codes as ophthalmology this year.

If you’ve become accustomed to glossing over ICD-10 updates every October since they don’t usually have a huge impact on eye care practices, know that those days are over. Effective Oct. 1, coders have 320 new diagnosis codes to choose from, and you’ll find that 172 codes have been revised.

The biggest changes impact ophthalmology and optometry practices. “All of the new ophthalmology codes are important, as they allow more specificity,” said Gina Vanderwall, OCS, CPC, CPPM, financial counselor with Finger Lakes Ophthalmology in Canandaigua, New York. “There will be a learning curve for providers with implementation, but overall I think they can only improve billing and coding.”

CMS published the full listing of codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to eye care offices.

Check Out New Eyelid Cancer Codes

Because ophthalmologists and optometrists are often the first clinicians to discover eyelid cancer, it’s important for them to identify the condition using diagnosis codes. You’ll find dozens of new codes in the eyelid cancer category, many of which were actually proposed by the AAO last year but were not implemented. However, this year, they’ll go live, so it’s important to know what they are.

Among the most robust changes are new codes under the C43.1 (Malignant melanoma of eyelid, including canthus) category, offering site-specific codes to denote exactly which eyelid is affected. One example is as follows:

• C43.111 — Malignant melanoma of right upper eyelid, including canthus
• C43.112 — Malignant melanoma of right lower eyelid, including canthus
• C43.121 — Malignant melanoma of left upper eyelid, including canthus
• C43.122 — Malignant melanoma of left lower eyelid, including canthus

Additional new codes then continue throughout the eyelid cancer section of ICD-10, describing the anatomic eyelid details, including upper or lower as well as right or left. These new codes impact the following categories with dozens of new code additions affecting laterality and upper/lower eyelid:

• C4A.1 -- Merkel cell carcinoma of eyelid, including canthus
• C44.10 -- Unspecified malignant neoplasm of skin and eyelid, including canthus
• C44.11 -- Basal cell carcinoma of skin of eyelid, including canthus
• C44.12 – Squamous cell carcinoma of skin of eyelid, including canthus
• C44.19 – Other specified malignant neoplasm of skin of eyelid, including canthus

You’ll also find additional site-specific codes for eyelid lesions in the “Neoplasms” section of ICD-10, such as D03.11 (Melanoma in situ of right eyelid, including canthus), D22.11 (Melanocytic nevi of right eyelid, including canthus), D23.12 (Other benign neoplasm of skin of left eyelid, including canthus), among several others.

The new specificity will require eye care physicians to clearly document the location of the affected eye and for coders to assign the corresponding code to reflect that condition. No longer is documentation of “basal cell carcinoma on eyelid and canthus” sufficient. The physician must note which eye was impacted, and whether it involved the upper or lower lid.

“While in some eye conditions laterality is sufficient in reporting, for eyelid cancer it is important to describe the actual lid involved and laterality,” the AAO said when it initially proposed these new codes last year.

New Category Debuts

You’ll also find an entirely new category (C44.13, Sebaceous cell carcinoma of skin of eyelid, including canthus). This new category will include seven new codes to describe the site or whether the location is unspecified.

This category will offer increased specificity for sebaceous carcinoma, a malignant tumor of the eyelid skin, rooted in the sebaceous glands. The condition is typically highly malignant and can be fatal, thus warranting the inclusion of its own code since this diagnosis may require a far more invasive treatment than less serious conditions impacting the eyelid.

Find New Blepharitis Codes

This year’s crop of new ICD-10 codes also includes several new diagnoses referring to blepharitis. You’ll now be able to report just one code when more than one eyelid is affected with blepharitis, rather than the current way, which requires you to bill multiple codes when you treat multiple eyelids. The new codes are as follows:

• H01.00A — Unspecified blepharitis right eye, upper and lower eyelids
• H01.00B — Unspecified blepharitis left eye, upper and lower eyelids
• H01.01A — Ulcerative blepharitis right eye, upper and lower eyelids
• H01.01B — Ulcerative blepharitis left eye, upper and lower eyelids
• H01.02A — Squamous blepharitis right eye, upper and lower eyelids
• H01.02B — Squamous blepharitis left eye, upper and lower eyelids

Today’s way: Currently, if a patient has ulcerative blepharitis of the right upper and lower eyelids, you’ll report both H01.011 (Ulcerative blepharitis right upper eyelid) and H01.012 (Ulcerative blepharitis right lower eyelid) to the payer.

2019 way: Effective Oct. 1, you’ll simply report H01.01A to reflect the condition that affects both the upper and lower right lids.

It’s possible that these massive changes to ophthalmology coding will require you to set up an educational session with the members of your practice, advising the clinicians on appropriate documentation processes so no detail is missing. Without that information, you won’t be able to most accurately select the right codes.

Ectropion, Lagophthalmos Codes Also Debut

In addition to the many new diagnosis codes for eye cancer and blepharitis, eye care coders who have struggled to find an appropriate code for paralytic ectropion, currently reported with the paralytic lagophthalmos (H02.23) series, will be pleased to find an entire new subcategory for paralytic ectropion of eyelid (H02.15) which includes seven codes that describe location and laterality of the affected eyelid.

You’ll also find new codes for multiple lagophthalmos conditions, such as unspecified (H02.20) cicatricial (H02.21), mechanical (H02.22), and paralytic (H02.23).