Ophthalmology and Optometry Coding Alert
Consider These Crucial 2024 ICD-10-CM Changes
Find expanded options for ocular conditions, SDoH, external causes, and more. With more than 400 new and revised codes joining the ICD-10-CM code set later this year, there’s a lot to unpack before the calendar flips to Oct. 1, 2023. And we’re here to help you sort it all out. Read on as we highlight the relevant changes that could impact your eye care practice’s bottom line come October. Eye the New H Codes Ophthalmologists manage and treat a myriad of different conditions, and soon, you’ll have a slew of new diagnosis codes to choose from. Many of the newly debuted changes are in Chapter 7, Diseases of the Eye and Adnexa, which will see 34 new additions and one revision. These novel H codes cover conditions such as sickle-cell retinopathy, eye muscle entrapment, and foreign body sensation and enable you to specify information regarding laterality. Sickle-cell retinopathy – 9 new codes Convert to parent: Starting Oct. 1, H36 (Retinal disorders in diseases classified elsewhere) will become an unreportable parent code instead of a stand-alone code. To choose the correct code from the novel H36.8 (Other retinal disorders in diseases classified elsewhere) group, you’ll need to know whether the retinopathy is nonproliferative or proliferative and which eye(s) are affected. The new 5-character codes include: For the first two groups, you’ll specify the eye affected using one of the following 6th characters — “1” for right eye, “2” for left eye, “3” for bilateral, and “4” for unspecified eye — to complete the retinopathy code. “To avoid invalid ‘truncated’ codes, you’ll need to stop reporting what will be a ‘parent code’ without the additional 5th and possibly 6th character required to identify the most specific diagnosis,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, revenue cycle director for Clinical Health Network for Transformation in Houston. Eye muscle entrapment – 21 new codes The 2024 ICD-10-CM code set introduces the following 5-character codes for eye muscle entrapment: For each of the muscle entrapment codes, the 6th character adds the following laterality information — “1” right eye, “2” left eye, “3” unspecified eye. Revised: ICD-10-CM 2024 also revises H54.511- from (Low vision, right eye, category 1-2) to (… right eye, category 1) and adds H54.512- (Low vision, right eye, category 2). Foreign body sensation, eye – 4 new codes Starting Oct. 1, you’ll choose from the following H57.8A- (Foreign body sensation eye (ocular)) codes to report ocular foreign body sensation: Examine External Causes ‘Foreign Body Entering Orifice’ Codes Most of the diagnosis code additions fall under added category W44 (Foreign body entering into or through a natural orifice) in Chapter 20, External Causes of Morbidity. The expansion provides 123 new codes you can report to capture accidents and injuries involving foreign bodies — batteries, plastic objects, glass, magnetic and non-magnetic metal items, rubber bands, food, insets, audio device, etc. — that enter or pass through a natural orifice. As with most external cause codes, you’ll add a 7th character to these new codes to indicate the type of encounter: A (... initial encounter), D (… subsequent encounter), or S (… sequela). Zero In on Z Code Additions Chapter 21, Factors Influencing Health Status and Contact with Health Services, exhibits the fourth-highest number of changes, with 30 new additions and six codes converted to parent. Remember, Z codes are critical to painting a complete picture of the patient’s circumstances and help gather data on treatment efficacy and the true cost of care. The newly introduced Z codes encompass various aspects of a patient’s health status, such as personal history of military service, newborn observation for suspected conditions ruled out, carriers of bacteria (Acinetobacter baumannii, Enterobacterales), family history of certain colonic polyps, and caregiver noncompliance. ICD-10-CM 2024 also enhances the Social Determinants of Health (SDoH) section, incorporating new codes related to child custody and parental/adult-child conflict. Don’t miss: Other notable diagnosis code updates for 2024 include: Take Steps To Keep Clean Claims and Appropriate Payments Medicare and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate the medical necessity for your ophthalmologist’s services. Also, Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later. As you prepare to implement the new ICD-10-CM changes on October 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado. First, review current documentation for each of the expanded categories. As your providers are currently documenting, would the verbiage support the level of specificity required to report the new codes? If not, meet with your providers to explain the new codes and increase their awareness of what the documentation requires. “You will also address the detail that is needed to support the highest level of specificity,” Peterson adds. “Also remember, the current EHR templates providers are using may require updates. And lastly, any internal billing or charge systems will need to make the new codes available” as of Oct. 1, 2023.
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