Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
From the October 2016 edition of AOA Focus, page 46-47.
On Oct. 1, 2016, hundreds of new ICD-10 codes that impact doctors of optometry went into effect.
Several additions and revisions have been made in Chapter 7 of the ICD-10 code set (diseases of the eye and adnexa [H00-H59]). These codes are commonly reported codes by doctors of optometry; however, many other code changes have occurred. Included below are just a few of these important changes.
New codes for amblyopia, AMD and glaucoma
New codes were added to the following subcategories:
- H53.04—Amblyopia suspect. This subcategory is also broken down by eye, bilateral and unspecified eye.
- H35.31—Non-exudative age-related macular degeneration (AMD). This subcategory is further delineated by eye, bilateral and unspecified, and these codes also require the addition of a seventh character to designate the stage of the disease.
- H35.32—Exudative AMD. This subcategory is further delineated by eye, bilateral and unspecified, and these codes also require the addition of a seventh character to designate the stage of the disease.
- H40.11—Primary open-angle glaucoma. This subcategory also is broken down by eye, bilateral and unspecified eye. Additionally, the stage of glaucoma also must be reported as in previous years.
New and revised codes for post-procedural complications
For doctors who co-manage patients and provide post-surgical care, it will be especially important to be aware of the revisions that have occurred to various codes that capture diagnoses related to post-procedural complications.
- The subcategory H59.3 has been revised to capture additional diagnoses related to post-procedural seroma.
- New codes have been added to distinguish between when complications occur following an ophthalmic procedure and complications that occur following a procedure other than an ophthalmic procedure.
Ask the coding experts
Evaluation and management (E/M) services are incredibly important in patient care, and it’s critical that optometry practices are aware of changes ahead. Meanwhile, the AOA and other leading physician organizations are pushing legislation that would halt Medicare payment cuts resulting from the changes.
Time to review your practice’s billing and coding: Access national benchmark data for optometry practices and join an upcoming webinar to learn more about E/M code changes in 2021.