Ophthalmology and Optometry Coding Alert

Hereditary corneal dystrophies, corneal transplant complications might be coded differently if proposals are finalized.

Coding for corneal dystrophy and complications after corneal transplant could be set for a big overhaul as part of the Oct. 1, 2019 ICD-10 update. That’s the word from the proposals that the ICD-10 Coordination and Maintenance Committee discussed during its March meeting.

The Committee will not make final decisions until later this year, but the following proposals are on the table and could impact eye care practices nationwide if they are approved.

Pinpointing Laterality

Coding corneal dystrophy can be frustrating because not every visit is for a bilateral diagnosis, but the existing codes assume that the condition affects both eyes. Therefore, coding these diagnoses can be frustrating, but help may be on the way -- codes for these conditions have been proposed for 2020.

“While the dystrophies are generally thought to be bilateral conditions, they may be asymmetric and may not require the same interventions,” the notes from the Coordination and Maintenance Committee Meeting state. “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 requested new codes for these conditions, and the new corneal dystrophy code suggestions are as follows:

• H18.501 – Unspecified hereditary corneal dystrophies, right eye
• H18.502 – Unspecified hereditary corneal dystrophies, left eye
• H18.503 – Unspecified hereditary corneal dystrophies, bilateral
• H18.509 – Unspecified hereditary corneal dystrophies, unspecified eye

Similar additions that specify laterality are proposed for endothelial corneal dystrophy (H18.511-H18.519), epithelial (juvenile) corneal dystrophy (H18.521-H18.529), granular corneal dystrophy (H18.531-H18.539), lattice corneal dystrophy (H18.541-H18.549), macular corneal dystrophy (H18.551-H18.559), and other hereditary corneal dystrophies (H18.591-H18.599).

Consider These Corneal Transplant Proposals

The AAO also suggested laterality-based additions for corneal transplant complications, as follows:

• T86.8401 – Corneal transplant rejection, right eye
• T86.8402 – Corneal transplant rejection, left eye
• T86.8403 – Corneal transplant rejection, bilateral
• T86.8409 – Corneal transplant rejection, unspecified eye

Similar laterality-based changes were suggested for corneal transplant failure (T86.8411-T86.8419), corneal transplant infection (T86.8421-T86.8429), other complications of corneal transplant (T86.8481-T86.8489), and unspecified complications of corneal transplant (T86.8491-T86.8499)

It remains to be seen whether these proposals will be approved and added to the 2020 edition of the ICD-10 manual, but the codes should be addressed at the committee’s next meeting, which takes place in September. Keep an eye on Ophthalmology and Optometry Coding Alert for more on this issue.