2020 updates to the ICD-10 code set
AOA's Coding Experts Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
Each year, the Centers for Disease Control and Prevention's ICD-10 Coordination Committee works with stakeholders to revise and update the code set. The AOA engages in this code update process to best reflect the clinical processes in the offices of doctors of optometry. While Oct. 1 is the official implementation date of the updated code set, some payors wait until the start of the calendar year to make code changes. It is recommended that you confirm with your local payors whether they will begin accepting these codes on Oct. 1.
New codes for fracture of orbital roof
The latest ICD-10 code changes create new codes for fracture of orbital roof. The new codes will be implemented as follows:
S02.12 Fracture of orbital roof
- S02.121 Fracture of orbital roof, right side
- S02.122 Fracture of orbital roof, left side
- S02.129 Fracture of orbital roof, unspecified side
By developing these new codes, the ICD-10 Coordination Committee has created a means for additional specificity. Previously, fracture of orbital roof was included under S02.19 "other fracture of base of skull."
There also are new codes for fracture of medial orbital wall and fracture of lateral orbital wall.
S02.83 Fracture of medial orbital wall
- S02.831 Fracture of medial orbital wall, right side
- S02.832 Fracture of medial orbital wall, left side
S02.84 Fracture of lateral orbital wall
- S02.841 Fracture of lateral orbital wall, right side
- S02.842 Fracture of lateral orbital wall, left side
New codes for failed vision screening
Beginning on Oct. 1, there also are new Z codes to denote when an exam occurs following a failed vision screening. Z codes are intended to be used for doctors to provide additional information on factors influencing health status and contact with health services.
When these codes were first considered by the ICD-10 Coordination Committee, the AOA voiced its concerns that there was a need for additional codes to be created for encounters that occur following a passed vision screening. The AOA believes that being able to denote when encounters occur when an individual had been told that they passed a screening would be useful to better capture limitations of vision screenings and to better assess their efficacy. For the latest code set update, the ICD-10 Coordination Committee unfortunately did not create the AOA's recommended new codes for encounters following a passed vision screening, but the AOA will continue to work with the committee to create codes that will be useful for data capture and analysis on this issue.
The new codes to indicate exams following a failed vision screening that will be implemented on Oct. 1 are:
- Z01.02 Encounter for examination of eyes and vision following failed vision screening.
Excludes1: encounter for examination of eyes and vision with abnormal findings (Z01.01); encounter for examination of eyes and vision without abnormal findings (Z01.00).
- Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings.
- Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings.
Use additional code to identify abnormal finding.
To ensure you have the latest updates to the ICD-10 code set, be sure to purchase the Codes for Optometry manual from the AOA Marketplace.
AOA member resources for coding
AOA Coding Today is an online, comprehensive database that contains information in real time for CPT, ICD-10 and HCPCS coding and research. The website is tailored specifically to optometry, assists doctors and staff in correct reimbursement and compliance, and has an easy-to-use code diagnosis ability based on region.
Complete the online form for direct access to coding experts for answers to your coding questions.
Purchase coding resources from the AOA Marketplace.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.