Optometry Coding & Billing Alert

Proposed diagnosis codes would break down ROP by stages

Good news for optometrists seeing patients with retinopathy of prematurity (ROP): Starting in October, you-ll be able to code more accurately with diagnosis codes for each stage of the condition.

CMS has released its list of new ICD-9 codes for 2009, including a new series describing stages 0-5 of ROP, a disease that can lead to blindness in prematurely born babies. The new codes take effect on Oct. 1, 2008 -- prior to that, optometrists- only option is to report 362.21 (Retrolental fibroplasia), which refers to the name that ROP used to be known by.

The more detailed codes will help with early intervention in the disease by distinguishing between minor and major ROP, according to information that Patrick Romano, MD, MPH, presented to the ICD-9-CM Coordination and Maintenance Committee on behalf of the Agency for Healthcare Research and Quality.

The new ICD-9 codes, and the ROS stages they describe, are:

- 362.20 (Retinopathy of prematurity, unspecified)

- 362.22 (Retinopathy of prematurity, stage 0) -- immature retina without vascular changes; no clear demarcation of vascular and avascular retina

- 362.23 (Retinopathy of prematurity, stage 1) -- mildly abnormal blood vessel growth; a flat line demarcates the vascular and avascular areas

- 362.24 (Retinopathy of prematurity, stage 2) -- moderately abnormal blood vessel growth; fibrous tissue protrudes into the vitreous between the vascular and avascular areas

- 362.25 (Retinopathy of prematurity, stage 3) -- severely abnormal blood vessel growth; new blood vessels and fibrous tissue along ridge or extending into vitreous

- 362.26 (Retinopathy of prematurity, stage 4) -- partial retinal detachment

- 362.27 (Retinopathy of prematurity, stage 5) -- total retinal detachment.

Look for: ICD-9 2009 will also introduce new codes for plateau iris syndrome (364.82), a condition optometrists sometimes see in managing post-iridectomy patients, and pingueculitis (372.34), which occurs when small corneal lesions known as pingueculae become swollen and inflamed.

In October, optometrists may also see more options for coding the diabetes that underlies many ophthalmic conditions. The new diagnosis codes include a new series, 249.xx, with 20 codes describing various manifestations of secondary diabetes mellitus (diabetes that occurs as a result of another medical condition).

Before October, physicians should still use 251.8 (Other specified disorders of pancreatic internal secretion) for secondary diabetes diagnoses.

Take note of these codes in the new 249.xx series:

- 249.50 -- Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified

- 249.51 -- Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled.

For type I or type II diabetes, continue to report codes from the 250.5x series (Diabetes with ophthalmic manifestations), with the fifth digit corresponding to whether the diabetes is type I, type II, controlled or uncontrolled.