Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
Excerpted from page 44 of the June 2017 edition of AOA Focus.
With the transition to ICD-10 in October 2015 came thousands of new diagnosis codes for doctors of optometry. Even more new diagnosis codes were implemented in October 2016, including about 750 related to the practice of optometry.
This most recent 2016 update was significant due to the backlog of codes that were not implemented because of a partial freeze prior to October 2015, when the Centers for Medicare & Medicaid Services (CMS) made the initial transition to ICD-10 codes. In the coming years, doctors should expect additional codes and revisions to the ICD-10 code set, but these changes should not be as significant as the 2015 and 2016 changes.
With so many diagnosis codes now in the ICD-10 code set, one would think there wouldn't be a need for additional codes. However, following the first two years of actual ICD-10 code usage in the United States, omissions and needed changes have been identified in the code set. The AOA is active in the code development and revision process in an effort to ensure the codes available for reporting are precise and accurate.
To oversee the ICD-10 code set, there is an ICD-10 Coordination and Maintenance Committee, which is a federal, interdepartmental committee comprised of representatives from CMS and the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS). The committee approves coding changes, develops errata, addenda and other modifications to the code set. Requests for coding changes are submitted to the committee for discussion. Presentations are provided during in-person committee meetings, and a public comment period follows the committee meeting. Final decisions on code revisions are made through a clearance process within the Department of Health and Human Services.
Most recently, the AOA submitted a code proposal for new diagnosis codes for Meibomian gland dysfunction (MGD). Although it's an incredibly common condition, no unique codes for MGD exist. The code proposal was discussed during the March 2017 meeting of the ICD-10 Coordination and Maintenance Committee and was supported by both optometry and ophthalmology.
During the committee meeting, new code proposals for Paralytic Ectropion of the Eyelid; Rosacea Conjunctivitis; Lagophthalmos; Eyelid Cancer; Orbital Roof and Wall Fracture and Thyroid Eye Disease were also discussed. Later this year, AOA will receive notification of whether any of these new codes have been finalized. AOA will update members on this and any other changes that have been proposed that would impact doctors of optometry.
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.