Ophthalmology and Optometry Coding Alert

Review this FAQ for a recap of the big changes from the last 12 months.

Whether you’re a new or seasoned coder, it can be challenging to keep up with all the coding updates that have been handed out each year. This year, for example, we’ve seen more than 400 new and revised ICD-10 codes and the completion of the evaluation and management (E/M) services overhaul.

That’s a lot to keep straight, so we’ve compiled answers to a few common questions surrounding the biggest shifts in coding practices from 2023 to help you feel confident heading into 2024.

Did ICD-10 2024 Introduce Any Eye-Related Codes?

Answer: The 2024 ICD-10 code set, which went into effect Oct. 1, 2023, greatly impacted Chapter 7, Diseases of the Eye and Adnexa, with 34 additions and one revision. Here’s an overview of the novel H codes that should now be a part of your coding arsenal.

Sickle-cell retinopathy: You should no longer be reporting H36 (Retinal disorders in diseases classified elsewhere), as it is now an unreportable parent code. Instead, use one of the nine new options from the novel H36.8- (Other retinal disorders in diseases classified elsewhere) group, requiring you to know whether the retinopathy is nonproliferative or proliferative and which eye(s) are affected.

The new 5-character codes include:

• H36.81- (Nonproliferative sickle-cell retinopathy)
• H36.82- (Proliferative sickle-cell retinopathy)
• H36.89 (Other retinal disorders in diseases classified elsewhere)

For the first two groups, 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: Also rolled out this fall were 21 new codes for eye muscle entrapment. The following 5-character codes also require a 6th character for laterality: “1” right eye, “2” left eye, “3” unspecified eye.

• H50.62- (Inferior oblique muscle entrapment)
• H50.63- (Inferior rectus muscle entrapment)
• H50.64- (Lateral rectus muscle entrapment)
• H50.65- (Medial rectus muscle entrapment)
• H50.66- (Superior oblique muscle entrapment)
• H50.67- (Superior rectus muscle entrapment)
• H50.68- (Extraocular muscle entrapment, unspecified)

Ocular foreign body sensation: The four new codes that fall under H57.8A- (Foreign body sensation eye (ocular)) include:

• H57.8A1 (Foreign body sensation, right eye)
• H57.8A2 (Foreign body sensation, left eye)
• H57.8A3 (Foreign body sensation, bilateral eyes)
• H57.8A9 (Foreign body sensation, unspecified eye)

Revised: ICD-10 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).

Have the Rules for Reporting Discarded Drugs Changed?

Answer: If your practice supplies and reports the drugs administered to patients, you should be familiar with using modifier JW (Drug amount discarded/not administered to any patient) when the provider administers part of a single-dose container and discards the rest. Reporting the discarded amount with modifier JW allows you to receive payment from Medicare Part B for the portion not administered.

When the calendar flipped to July 1, 2023, Medicare put a new drug reporting requirement into effect. You now need to use the novel, related modifier JZ (Zero drug amount discarded/not administered to any patient) when there is no discarded amount from a single-dose container subject to modifier JW rules. You should submit either -JW or -JZ, depending on whether or not there is any drug wasted following administration.

Tip: Modifier JZ goes on one claim line with the HCPCS Level II code for the drug administered and the number of units given to the patient.

“Continue reporting two claim lines when some amount of the single-use vial is discarded. Report the number of units administered on one line and, using the same HCPCS code plus modifier JW, report the discarded units on a separate line,” notes Mary Pat Johnson, CPC, CPMA, COMT, COE, senior consultant with Corcoran Consulting Group.

What Changes Did the 2023 E/M Overhaul Bring?

Answer: Coding and documentation for E/M services carry fewer administrative burdens in 2023 as landmark reforms that were implemented in 2021 for E/M services performed in outpatient and office settings have been carried over to all healthcare settings, including hospitals, emergency departments, nursing facilities, and patient homes.

Refresher: Changes to E/M coding in 2021 included providing physicians the flexibility to select a level of service for an outpatient visit based on the complexity of medical decision making (MDM) or total time spent by the physician on the day of service.

This year, in one fell swoop, CPT^® got rid of its per-day initial and subsequent outpatient hospital observation codes. Instead, you should now be using one of the existing inpatient hospital care codes, which received extensive descriptor revisions, allowing you to use MDM or time to guide code selection.

Initial inpatient/observation care: 99221-99223 (Initial hospital inpatient or observation care, per day which requires a medically appropriate history and/or examination and straightforward or low/moderate/high level medical decision making …)

Subsequent inpatient/observation care: 99231-99233 (Subsequent hospital inpatient or observation care, per day … which requires a … low/moderate/high level of medical decision making …)

CPT^® 2023 also updated the following E/M codes:

• 99282-99285 (Emergency department visit …)
• 99242-99245 (Office or other outpatient consultation …)
• 99234-99236 (Hospital inpatient or observation care … including admission and discharge on the same date …)

Impact: With CPT^® 2023 removing all references to level of history and physical examination from the remainder of the E/M code descriptors and replacing them with a “medically appropriate” history and exam, the note can home in on the presenting problem instead of the three key components. This shift in focus means it is no longer necessary to include extraneous information not relevant to the medical issues at hand in the documentation. Instead, efforts should be geared toward supporting the E/M level based on MDM or total time, bringing the codes of the remainder of E/M services in line with the office/outpatient E/M codes.

Exception: Time-based code selection does not apply to the emergency department (ED) codes — the level of an ED service is based solely on MDM.

Have Any New Z Codes Been Added Lately?

Answer: ICD-10 2024 brought significant change to Chapter 21, Factors Influencing Health Status and Contact with Health Services (Z00-Z99), with 30 new codes and six codes converted to parent. The Z codes that went into effect Oct. 1 encompass various aspects 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.

The 2024 update also enhanced the Social Determinants of Health (SDoH) section, providing you with more ways to report notable child-guardian relationships, thanks to new codes like Z62.23 (Child in custody of non-parental relative), Z62.823 (Parent-step child conflict), and Z62.832 (Non-relative guardian-child conflict).