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
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 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.