icd-10 coding for contact lens problems the...

ICD-10 Coding for Contact Lens Problems

The EyeCodingForum.com

Jeffrey Restuccio, CPC, CPC-H, MBAMemphis TN

(901) [email protected]

EyeCodingForum.com 1

Coding for Contact Lens Complications

• Many common conditions/diseases are not listed in the current ICD-9 manual. How will they translate to ICD-10? Will it correct all the omissions and incorrect descriptions currently found in ICD-9?

• For the most part, no.• Yes, Dry Eye Syndrome will now be part of the ICD-10 code

description.

• But many will continue to retain international descriptions that are different from common terms used in the United States.


H04.121 Dry eye syndrome of right lacrimal gland

Top Five Contact Code Problem ICD-9 Codes/Conditions

• ICD-9 and Description


ICD-9 Description368.8 Blurred Vision

379.91 Eye Pain 379.93 Redness of Eyes 375.15 Dry Eyes

368.2 Double Vision/diplopia

This list includes about 80% of visits for contact lens-relatedproblems.

ICD-10 Crosswalk• Note separate diplopia and double vision codes.


1) H57.8 Other specified disorders of eye and adnexa [blurred vision crosswalk]

2) H57.13 Ocular pain, bilateral [four codes]3) H57.8 Other specified disorders of eye and adnexa [redness]4) H04.121 Dry eye syndrome of right lacrimal gland [four codes]5) H53.2 Diplopia [ICD-9 crosswalk to 368.2]

H53.19Other subjective visual disturbances [Includes: Double vision; ICD-9 crosswalk: 368.15]

368.15: Subjective visual disturbances: other visual distortions and entoptic (visual effects whose source is within the eye itself) phenomena

Common Coding Errors

• The two codes are recommended above but 375.15 is clearly incorrect per ICD-9 guidelines.


371.82 Corneal Disorder due to Contact Lens

375.15Corneal Edema due to Wearing of Contact Lens [this is an error per ICD-9]

371.82Other corneal disorders: corneal disorder due to contact lensExcludes corneal edema due to contact lens (371.24)

371.15

Corneal pigmentations and deposits: other deposits associated with metabolic disorders [actual ICD-9description]

Correct Contact ICD-10 Codes

• Correct ICD-9 code


371.24Corneal edema: corneal edema due to wearing of contact lenses

H18.219Corneal edema secondary to contact lens, unspecified eye

371.82 Corneal Disorder due to Contact Lens

H18.829 Corneal disorder due to contact lens, unspecified eye

Other conditions

• How does one code for: more serious conditions like corneal hypoxia, infiltrates, and microbial keratitis?


Terms and definitions• SEAL: Superior Epithelial Arcuate Lesion: It is a white lesion in the

superior cornea that can be up to 0.5 mm wide and from 1 mm to 5 mm long.

• CLARE: Contact Lens-induced Acute Red Eye: A sudden onset of a corneal infiltrative event observed during extended wear of hydrogel contact lenses that is always associated with sleep. Patients report waking up with irritation or pain, redness and watery eyes. Sometimes, these symptoms are not noticed until soon after waking (HPI: timing).

• CLPU: Contact Lens-induced Peripheral Ulcer: A circular, well-circumscribed, dense, yellowish-white, focal corneal infiltrate (0.2 mm to 2.0 mm in diameter) located in the peripheral to mid-peripheral cornea. It is always located in the anterior stroma and has a complete loss of overlying epithelium. Symptoms can vary but may include pain or soreness, irritation and watering.


Terms and definitions

• Microcysts: Small (15 μm to 50 μm), irregularly shaped inclusions, typically found in the paracentral to mid-peripheral zones of the cornea, best observed with retro-illumination. These show reversed illumination due to a suspected higher refractive index than the surrounding tissue.

• Often clear and asymptomatic. Report the underlying symptoms:


Terms and definitions

• MK — Microbial Keratitis: occurs as a result of an infection of the cornea by replicating microbes (bacterial, viral, fungal or amoebae). In contact lens wear, it is usually preceded by hypoxia and/or an epithelial break. Contact lens wearers, in particularly extended wear, are more prone to develop MK. The most common bacteria associated with contact lens-related MK is Pseudomonas aeruginosa.

• Bacteria tend to bind to the back surface of silicone hydrogel lenses after patients have been swimming. Always recommend that patients remove and disinfect their lenses after any exposure to pools, lakes or rivers.


Top MK Symptoms ICD-9 Codes

• Top codes


1 370.03 Corneal Ulcer, Central 2 364.03 Secondary Iridocyclitis, Infectious

3 379.91Unspecified disorder of eye and adnexa: pain in or around eye [eye pain]

4 379.93Other specified disorders of eye and adnexa [redness of Eyes]

4 375.21 Epiphora5 368.13 Photophobia

Top MK Symptoms ICD-9 Codes• ICD-10 crosswalk. Not always exact.


1 H16.011 Corneal Ulcer, Central 2 Secondary Iridocyclitis, Infectious

H20.031Secondary infectious iridocyclitis, right eye [also noninfectious, H20.041]

3 H57.13 Ocular pain, bilateral4 H57.8 Redness of Eyes [no eye code]5 H04.201 Unspecified epiphora, right lacrimal gland

H04.211Epiphora due to excess lacrimation, right lacrimal gland

H04.221Epiphora due to insufficient drainage, right lacrimal gland

Top MK Symptoms ICD-9 Codes• ICD-10 crosswalk. Not always exact.

• Only report those codes documented, relevant to this encounter, and sufficient to support medical necessity for a given procedure or office visit.


6 H53.149 Photophobia

H53.149

Visual discomfort, right eye [Includes: Metamorphopsia; photophobia term not in ICD-10]

Other Complications

• Exposure keratitis is not found in the ICD-9 manual. It is listed as: exposure keratoconjunctivitis

• It is an incomplete closure of the eyelid causing a dry, inflamed eye.


370.34Certain types of keratoconjunctivitis: exposure keratoconjunctivitis

H16.219 Exposure keratoconjunctivitis, unspecified eye

Exposure keratoconjunctivitis

• All codes; Note codes are not by eyelid.


H16.211 Exposure keratoconjunctivitis, right eyeH16.212 Exposure keratoconjunctivitis, left eyeH16.213 Exposure keratoconjunctivitis, bilateral

H16.219 Exposure keratoconjunctivitis, unspecified eye

Keratoconjunctivis sicca

• Keratoconjunctivitis sicca has two options in ICD-9.• The condition involves reporting biomicroscopic findings

without referring to the underlying cause.


710.2 Diffuse diseases of connective tissue: sicca syndrome Keratoconjunctivitis siccaSjogren's disease [Sjögren's syndrome]

370.33

Certain types of keratoconjunctivitis: keratoconjunctivitis sicca, not specified as Sjogren's [dry eyes]

Remember, International Definitions

• Keratoconjunctivitis sicca (KCS), (aka keratitis sicca, xerophthalmia or dry eye syndrome, is an eye disease caused by eye dryness it is caused by either decreased tear production or increased tear-film evaporation.


H16.221Keratoconjunctivitis sicca, not specified as Sjögren's, right eye

H16.222Keratoconjunctivitis sicca, not specified as Sjögren's, left eye

H16.223Keratoconjunctivitis sicca, not specified as Sjögren's, bilateral

H16.229Keratoconjunctivitis sicca, not specified as Sjögren's, unspecified eye

Dry Eye Syndrome

• Use the following ICD-10 code for DES


H04.121 Dry eye syndrome of right lacrimal glandH04.122 Dry eye syndrome of left lacrimal glandH04.123 Dry eye syndrome of bilateral lacrimal glandsH04.129 Dry eye syndrome of unspecified lacrimal gland

Sicca Syndrome ICD-10

• GEMS Crosswalk of ICD-9: 710.2• Listed also as Sjögren's syndrome: a systemic autoimmune

disease in which immune cells attack and destroy the exocrine glands, which produce tears and saliva. Unless it was diagnosed separately, M35.01 would be the correct code.


ICD-10 DescriptionM35.00 Sicca syndrome, unspecified M35.01 Sicca syndrome with keratoconjunctivitis

More Terms• CLPC : Contact Lens-induced Papillary Conjunctivitis (Aka Giant

Papillary Conjunctivitis [GPC]): Symptoms may range from mild hyperemia of the upper tarsal conjunctiva with a few, small papillae to severe hyperemia with large, raised papillae, which have a cobblestone appearance. CLPC may present as a localized or generalized response. Symptoms include itching and a stringy or ropy mucous discharge. Excessive lens movement or decentrationand blurred vision may also occur. Lens material, design or fitting characteristics may need to be modified to prevent recurrence of this condition. Etiologies for CLPC include: mechanical abrasion from poor edge design and protein film abrasiveness.

• A code does exist, but it's not called GPC. It all depends on the etiology. Since papillae aren't follicles, we can't use the code for follicular conjunctivitis.


Incorrect Coding• Some Eyecare coding consultants recommend code 372.10,

chronic conjunctivitis, unspecified, for an allergic underlying cause. Again, there are additional codes:


372.14Chronic conjunctivitis: other chronic allergic conjunctivitis

H10.401 Unspecified chronic conjunctivitis, right eyeH10.411 Chronic giant papillary conjunctivitis, right eyeH10.421 Simple chronic conjunctivitis, right eyeH10.431 Chronic follicular conjunctivitis, right eye

More Dx

• Ulcers of the eye; note by eye.


H16.001 Unspecified corneal ulcer, right eyeH16.011 Central corneal ulcer, right eyeH16.021 Ring corneal ulcer, right eyeH16.031 Corneal ulcer with hypopyon, right eyeH16.041 Marginal corneal ulcer, right eyeH16.051 Mooren's corneal ulcer, right eyeH16.061 Mycotic corneal ulcer, right eyeH16.071 Perforated corneal ulcer, right eye

Other Complications

• More codes


ICD-9 ICD-10 Description370.6 H16.401 Corneal Neovascularization

370.64 H16.419 Corneal Ghost Vessels

24

Sample CMS-1500 Form

Use for unlisted codes, co-management and unique situations

92225 -RT

377.00 Papilledema

11 103/1/2010

92014 03/1/2010 11

V58.69 High Risk Med - Plaquenil

714.0 Rheumatoid arthritis

2,3

03/1/2010 11

077.3 Other adenoviral conjunctivitis

87809 4

Use for unlisted codes, co-management and unique situations

Crosslinks

• ICD-10 codes

• Is this correct?


ICD-9 ICD-10 Description

377.00 H47.10 Papilledema [unspecified]

V58.69 Z79.899 High Risk Med - Plaquenil

714.0 M06.9 Rheumatoid arthritis

077.3 B30.1 Other adenoviral conjunctivitis

Not exactly• There’s always more. These are the ICD-10 descriptions.

• The ICD-10 codes must be reviewed individually—now before the implementation date; otherwise you will be substituting old unspecific codes for new unspecific codes—that may be inaccurate and cause a denial.


377.00 H47.10 Unspecified papilledema

V58.69 Z79.899 Other long term (current) drug therapy

714.0 M06.9 Rheumatoid arthritis, unspecified

077.3 B30.1 Conjunctivitis due to adenovirus

Papilledema codes

• More papilledema codes.


H47.10 Unspecified papilledema

H47.11Papilledema associated with increased intracranial pressure

H47.12 Papilledema associated with decreased ocular pressureH47.13 Papilledema associated with retinal disorder

Rheumatoid arthritis

• Rheumatoid arthritis


M06.00Rheumatoid arthritis without rheumatoid factor, unspecified site [More 6th digit site codes]

M06.80Other specified rheumatoid arthritis, unspecified site

Adenovirus

B30.0 Keratoconjunctivitis due to adenovirusB30.1 Conjunctivitis due to adenovirus [crosswalk]B30.2 Viral pharyngoconjunctivitis

B30.3Acute epidemic hemorrhagic conjunctivitis (enteroviral)

B30.8 Other viral conjunctivitisB30.9 Viral conjunctivitis, unspecified


The Bottom Line• While many codes have a clean crosswalk most problems are

crosswalking an unspecific ICD-9 code to an unspecific ICD-10 code.

• The ICD-10 codes must be reviewed early to determine which are relevant and which are not.

• Most won’t even know the correct questions to ask. I will help you ask the right questions.

• That is the goal of the complete ICD-10 training course and additional webinars we will be conducting throughout 2014.

• Many carriers will not have representatives knowledgeable about Eyecare. It will be a challenge determining which codes they require after the October 1 2014 implementation date.


Questions?

• If you order the complete ICD-10 training course ($225) or the $299 bundle after purchasing this 50-minute Webinar for $49, contact [email protected] for a rebate code.

• The EyeCodingForum is your one-stop source for all ICD-10 coding updates.

• In addition, we will continue to have monthly webinars on coding, billing, documentation and compliance topics relevant to Eyecare (both Optometrists and Ophthalmologists).


Thank you for listening to the EyeCodingForum’s

ICD-10 Coding for Contact Lens Problems

Jeffrey Restuccio, CPC, CPC-H, MBAMemphis TN

(901) [email protected]


icd-10 coding for contact lens problems the...

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