Ophthalmology and Optometry Coding Alert

New diagnosis-code book will change cataract dx codes -- and everything else.

If you think keeping up with the new 2009 ICD-9 codes is tough, just wait -- in three years, you might have more than 155,000 new codes to deal with.

What happened: On Aug. 15, the Department of Health and Human Services (HHS) announced a proposal to replace the ICD-9 codes with the ICD-10 series effective Oct. 1, 2011. Not only will this new code set require an overhaul of your

claims systems, software, and superbills, it will most likely require retraining for your entire staff. But there will also be costs associated with not changing to the new diagnosis coding system, warns Jeanne Yoder, RHIA, CCS-P, CPC, billing

director for a health care chain and approved Professional Medical Coding Curriculum (PMCC) instructor, who led the Coding Institute's audioconference "Smart Preparations for ICD-10 Coding." Without ICD-10, your practice may have insufficient

data to make informed decisions, she says. A recent CMS MLN Matters article (SE0832) states, "Compared to the current ICD-9 classification system, ICD-10 offers more detailed information and the ability to expand specificity and clinical

information in order to capture advancements in clinical medicine. Providers may want to become familiar with the new coding system."

And there is also the cost in training staff on ICD-9, then having to retrain them on ICD-10 in 2011, Yoder notes. The ICD-9 code series you're familiar with includes about 17,000 codes. The ICD-10 code set contains more than 155,000 codes,

including the Volume 3 Procedure Coding System (PCS) codes. That's a lot to wrap your mind around.

For example: In the United States, there is only one code for senile incipient cataract: 366.12 (Incipient cataract). ICD-9 provides no more detailed diagnosis coding beyond that point.

ICD-10, however, provides the following diagnoses under "age-related incipient cataract" (H25.0):

•H25.01 -- Cortical age-related cataract

•H25.011-- Cortical age-related cataract, right eye

•H25.012 -- Cortical age-related cataract, left eye

•H25.013 -- Cortical age-related cataract, bilateral

•H25.019-- Cortical age-related cataract, unspecified eye

•H25.03 -- Anterior subcapsular polar age-related cataract

•H25.031 -- Anterior subcapsular polar age-related cataract, right eye

•H25.032 -- Anterior subcapsular polar age-related cataract, left eye

•H25.033 -- Anterior subcapsular polar age-related cataract, bilateral

•H25.039 -- Anterior subcapsular polar age-related cataract, unspecified eye

•H25.04 -- Posterior subcapsular polar age-related cataract

•H25.041 -- Posterior subcapsular polar age-related cataract, right eye

•H25.042 -- Posterior subcapsular polar age-related cataract, left eye

•H25.043 -- Posterior subcapsular polar age-related cataract, bilateral

•H25.049 -- Posterior subcapsular polar age-related cataract, unspecified eye

•H25.09 -- Other age-related incipient cataract.

CMS: ICD-10 More Specific With Less Paperwork

These examples are among several other options. These are the codes used by most industrialized countries around the world already, as classified by the World Health Organization (WHO).

According to CMS, ICD-10 incorporates greater specificity and clinical information to the codes. Changes should result in an improved ability to measure healthcare services and enhance CMS's ability to conduct public health surveillance.

Bonus for coders: Another of ICD-10's goals is to decrease your need to include supporting documentation with claims, which should make both you and your physicians happy. ICD-10 also includes updated medical terminology and

classification of diseases -- among many other changes.

Head start: To read more about the ICD-10 changes, visit the CMS Web site at http://www.cms.hhs.gov/ICD10. To listen to Yoder's audioconference, visit www.audioeducator.com/industry_conference.php?id=1304