Coding changes to know before Oct. 1
The National Center for Health Statistics (NCHS) is the federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision—ICD-10, as most of us know it. On an annual basis, changes are made to the code set to reflect clinical updates, previous omissions and to allow for revisions to be made to the current codes. The AOA engages with the ICD-10 Coordination and Maintenance Committee, a federal interdepartmental committee made up of representatives from the NCHS and the Centers for Medicare and Medicaid Services. Suggestions for modifications to the code set are taken from the public and private sectors. Final decisions on code revisions are made through a clearance process within the Department of Health and Human Services.
The 2018-2019 code set updates will go into effect on Oct. 1, 2018. The updated code sets include a number of codes. The updated Codes for Optometry manual is available for sale from the AOA Marketplace. Included below are a few changes that doctors of optometry should be aware of:
Epiphora (H04.2) codes have been revised to reflect "side" rather than lacrimal gland:
- H04.201 Unspecified epiphora, right side
- H04.202 Unspecified epiphora, left side
- H04.203 Unspecified epiphora, bilateral
- H04.209 Unspecified epiphora, unspecified side
New codes were added to reflect Rosacea conjunctivitis as below:
- H10.821 Rosacea conjunctivitis, right eye
- H10.822 Rosacea conjunctivitis, left eye
- H10.823 Rosacea conjunctivitis, bilateral
- H10.829 Rosacea conjunctivitis, unspecified eye
Additionally, new codes were added for Brow ptosis:
- H57.811 Brow ptosis, right
- H57.812 Brow ptosis, left
- H57.813 Brow ptosis, bilateral
- H57.819 Brow ptosis, unspecified
At AOA's recommendation, new codes were also developed for meibomian gland dysfunction of eyelid as noted below:
- H02.881 Meibomian gland dysfunction right upper eyelid
- H02.882 Meibomian gland dysfunction right lower eyelid
- H02.883 Meibomian gland dysfunction of right eye, unspecified eyelid
- H02.884 Meibomian gland dysfunction left upper eyelid
- H02.885 Meibomian gland dysfunction left lower eyelid
- H02.886 Meibomian gland dysfunction of left eye, unspecified eyelid
- H02.889 Meibomian gland dysfunction of unspecified eye, unspecified eyelid
- H02.88A Meibomian gland dysfunction right eye, upper and lower eyelids
- H02.88B Meibomian gland dysfunction left eye, upper and lower eyelids
For the complete list of changes, be sure to purchase the 2019 Codes for Optometry manual. However, it's important to note that you must refrain from using these codes until after Oct. 1, 2018.
Need coding help? Access AOA resources
AOA Coding Today is an online, comprehensive database containing information in real time for CPT, ICD-10 and HCPCS coding and research. The website is tailored specifically to optometry and assists doctors and staff in correct reimbursement and compliance, and has an easy-to-use code diagnosis ability based on region. Use this free member resource to assist you immediately with your coding questions.
If you have specific coding questions that are not addressed through AOA Coding Today, direct them to AOA's Coding Experts.
If you have suggestions for how AOA can best support the coding needs of doctors of optometry, please contact Kara Webb, AOA's director for coding and regulatory policy.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, 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.