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Coding & Reimbursement

ICD-10-CM in the new year

Every year, we face coding changes. Let’s look at those made to ICD-10-CM. These were published Oct. 1, 2018, and were effective immediately. This years’ code updates affect eye care mostly in the eyelids, brow, conjunctiva and meibomian gland areas.

Q. What are the new codes?

A. Here are the new codes and the code changes that are likely to be commonly used in an eye-care practice. For simplicity, we have divided them by chapter.

CHAPTER 2 - NEOPLASMS

The neoplasm chapter now has options for upper and lower eyelids. Ever since the initial roll-out of ICD-10, this has been frustrating. For example:

  • C43.111 Malignant melanoma of RU eyelid, incl. canthus
  • C43.112 Malignant melanoma of RL eyelid, incl. canthus
  • C43.121 Malignant melanoma of LU eyelid, incl. canthus
  • C43.122 Malignant melanoma of LL eyelid, incl. canthus

Other changes in this section:

  • Merkel cell (C4A.-), Basal cell (C44.11-), Squamous cell (C44.12-), and Sebaceous cell (C44.13-)
  • Melanoma in situ (D03.1-) and Carcinoma in situ (D04.1-)
  • Melanocytic nevi (D22.1-) and “Other benign neoplasm of skin (eyelid)” (D23.1-)

CHAPTER 7 - EYES

The eye chapter includes changes to the blepharitis codes; they allow for both lids on one side to be selected. For example:

  • H01.00A Unspecified blepharitis right eye, upper and lower eyelids
  • H01.00B Unspecified blepharitis left eye, upper and lower eyelids

Other blepharitis codes have received similar changes:

  • Ulcerative blepharitis (H01.01A and H01.01B)
  • Squamous blepharitis (H01.02A and H01.02B)

For lagophthalmos, we now have “both lids right” and “both lids left” as well as an “all 4 lids” option:

  • H02.20A Unspecif. lagophthalmos right eye, upper and lower eyelids
  • H02.20B Unspecif. lagophthalmos left eye, upper and lower eyelids
  • H02.20C Unspecif. lagophthalmos, bilateral, upper and lower eyelids

Other lagophthalmos codes have the same changes:

  • Cicatricial (H02.21A - H02.21C)
  • Mechanical (H02.22A - H02.22C)
  • Paralytic (H02.23A - H02.23C)

Paralytic ectropion is a new code; multiple options exist, although you are advised to use caution for the codes below ending in “3,” “6,” or “9” for lack of specificity.

  • H02.151 Paralytic ectropion of right upper eyelid
  • H02.152 Paralytic ectropion of right lower eyelid
  • H02.153 Paralytic ectropion of right eye, unspecified eyelid
  • H02.154 Paralytic ectropion of left upper eyelid
  • H02.155 Paralytic ectropion of left lower eyelid
  • H02.156 Paralytic ectropion of left eye, unspecified eyelid
  • H02.159 Paralytic ectropion of unspecified eye, unspecified eyelid

Meibomian gland dysfunction (MGD) treatment has been a recent focus for many practices, and the ICD-10 coding changes are, therefore, most welcome; no longer are less precise codes required. These new MGD codes are:

  • H02.881 Meibomian gland dysfunction right upper eyelid
  • H02.882 Meibomian gland dysfunction right lower eyelid
  • H02.883 Meibomian gland dysfunction right eye, unspecified lid
  • H02.884 Meibomian gland dysfunction left upper eyelid
  • H02.885 Meibomian gland dysfunction left lower lid
  • H02.886 Meibomian gland dysfunction left eye, unspecified lid
  • H02.889 Meibomian gland dysfunction 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

Other new codes in our chapter cover the conjunctiva and eyebrow. Having a “brow ptosis” code in ICD-10 is a particularly welcome change for oculoplastics, since ICD-9 offered a “real code” for this but we have not had a specific code in ICD-10 until now:

  • H10.82 Rosacea conjunctivitis
    • Code first underlying rosacea dermatitis (L71.-)
    • H10.821 Rosacea conjunctivitis, right eye
    • H10.822 Rosacea conjunctivitis, left eye
    • H10.823 Rosacea conjunctivitis, bilateral
    • H10.829 Rosacea conjunctivitis, unspecified eye
  • H57.81 Brow ptosis
  • H57.811 Brow ptosis, right
    • H57.812 Brow ptosis, left
    • H57.813 Brow ptosis, bilateral
    • H57.819 Brow ptosis, unspecified
    • H57.89 Other specified disorders of eye and adnexa

Some codes in Chapter 7 received more subtle changes; the code number is the same, but the instructions or a detail about it is new:

  • H04.2- (epiphora). “Lacrimal gland” was changed to “side”, instead of “right and left” — it still means right eye and left eye
  • H10.51 Ligneous conjunctivitis (only a “Code also” change): Code also underlying condition if known, such as: plasminogen deficiency (E88.02)

OTHER CHAPTERS

Here are some additional useful codes in other chapters:

Chapter 12 - L51 Erythema multiforme; the only change is a new instruction: Use additional code for associated manifestations, such as: edema of eyelid (H02.84-).

Chapter 16 - P35.4 Congenital Zika virus disease: Use additional code to identify manifestations of congenital Zika virus disease.

Chapter 19 - T81 Complications of procedures, not elsewhere classified:

  • T81.4 Infection following a procedure:
  • Changed the “Excludes1” (all) to an “Excludes2” (all) notation
  • T81.41 Infection following procedure, superficial incision surgical site
  • T81.42 Infection following procedure, deep incisional surgical site
  • T81.43 Infection following procedure, organ and space surgical site
  • T81.44 Sepsis following a procedure: Use additional code to identify the sepsis
  • T81.49 Infection following a procedure, other surgical site

CONCLUSION

Every Oct. 1, ICD-10 is updated; the number of changes this year are less comprehensive than in the past, but still important.

When a new code is created, you must use it to the greatest specificity. OM