Ophthalmology and Optometry Coding Alert

Question: We had a patient present who fell from a ladder and hurt his eye. We were looking for the appropriate “external cause” code in ICD-10 and found W11 (Fall on and from ladder), but it requires a 7^th character. The manual lists several options for the final character—but that means we’re still missing three characters in the middle of the code. Can you advise?

Answer: Some ICD-10 codes extend to a seventh character, while others do not, and in some cases, filling in the “holes” between the end of the primary code and the beginning of the last character means you’ll have to use the letter “X” to fill in the blanks that are missing.

Background: If you encounter a code that has a seventh character, it means that to complete the ICD-10 code, you have to know how many times the patient has reported to your practice for that particular problem.

ICD-10 uses the seventh-character extensions to provide additional information about the characteristic of the encounter for episode of care for obstetrics, injuries and external causes of injuries. So in the case of a fall from a ladder, you’ll report W11XXXA for the initial encounter (Fall on and from ladder; initial encounter).

If it’s the subsequent encounter, your appropriate code is W11XXXD (…subsequent encounter), and if the patient is being seen for the sequela of the injury, report W11XXXS (…sequela).

The initial encounter is the first encounter with that provider for this problem and thus the subsequent encounters are the follow-up visits. A sequela event is when the patient had the problem some time ago and has noticed the issue is again bothersome, symptomatic or has not completely healed.

If the seventh character is there in the ICD-10 book for a diagnosis code, you must include one.  For example, W11 would be considered a truncated or non-valid ICD-10 code, so be sure to use the “X” fillers to your advantage in these situations.