Ophthalmology and Optometry Coding Alert

Hint: Your diagnosis coding will depend on which eye was infected once ICD-10 hits.

When ICD-9 becomes ICD-10 in 2013, you'll have to be prepared for changes across the board when it comes to diagnosis coding. Often, you'll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options.

Get ready now: The deadline for using ICD-10 is Oct. 1, 2013, with no grace period, stresses Pat Brooks, RHIA, senior technical advisor with CMS.

Nail Down These Upcoming Eye Infection Coding Changes

Conjunctivitis is an eye infection that can affect patients of all ages, and your practice is probably familiar with the signs and symptoms of this condition. But, like all other conditions, conjunctivitis will fall under new codes under ICD-10.

You currently have several coding options for conjunctivitis, depending on the type of condition that the physician treats. The following is a sampling of ICD-9 codes that most practices use:

• 372.00 -- Acute conjunctivitis, unspecified
• 372.01 -- Serous conjunctivitis, except viral
• 372.05 -- Acute atopic conjunctivitis
• 372.10 -- Chronic conjunctivitis, unspecified
• 372.11 -- Simple chronic conjunctivitis
• 372.30 -- Conjunctivitis, unspecified.

ICD-10 changes: Under ICD-10, you'll not only have to denote the specific type of conjunctivitis by using the accurate diagnosis code, but you'll also have to indicate which eye was affected. The following is a sampling of ICD-10 codes that will affect ophthalmologists under the new coding system.

• H10.10 -- Acute atopic conjunctivitis, unspecified eye
• H10.11 -- Acute atopic conjunctivitis, right eye
• H10.12 -- Acute atopic conjunctivitis, left eye
• H10.13 -- Acute atopic conjunctivitis, bilateral
• H10.2x -- Serous conjunctivitis, except viral...
• H10.3x -- Unspecified acute conjunctivitis...
• H10.40x -- Unspecified chronic conjunctivitis...
• H10.9 -- Unspecified conjunctivitis.

The "x" designations above show where you'll input an additional digit to denote the affected eye. As shown in the H10.10-H10.13 range above, you will have options for the left eye, right eye, bilateral, or unspecified in most categories under ICD-10.

Documentation: Your physicians should already be including the affected eye in their documentation. All you need to do as a coder to capture this already present information is to format your superbill to capture the additional anatomical information.

Coder tips: On your superbill, after "conjunctivitis," list the available options to prompt the physician to enter this information. A condensed system could include:

• H10.3x, Unspecified acute conjunctivitis (x=0 for unspecified eye, 1 for right eye, 2 for left eye, and 3 for bilateral)
• H10.40x, Unspecified chronic conjunctivitis (x=1 for right eye, 2 for left eye, 3 for bilateral, and 9 for unspecified eye).

Important: Note that the "x" digits in the H10.3x and H10.40x examples above don't translate exactly from one conjunctivitis condition to the other. For H10.3x, a "0" for the final digit refers to an unspecified eye, whereas for H10.40x, a "9" for the final digit refers to an unspecified eye. Therefore, physician training will be imperative for this condition, and the coder should screen all conjunctivitis diagnoses immediately after ICD-10 implementation before sending claims out to the insurer.