pqrs and e-prescribing vicchrilli_nanos 2013.pdf · new: achieved meaningful use sometime between...

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES

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NANOS

Diagnosing and Treating Neuro-Ophthalmology

Coding Problems


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Financial Disclosure

Sue Vicchrilli, COT, OCS Academy Coding Executive


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North American Neuro-Ophthalmology Society 39th Annual Meeting • February 9 - 14, 2013

Snowbird Ski Resort – Snowbird, UT

FINANCIAL DISCLOSURE

I do not have any financial interests or relationships to disclose.


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Topics

PQRS/E-Prescribing

Examinations Evaluation and Management

Eye Codes

Testing Services Unilateral/Bilateral

Bundling Edits

Multiple Procedure Payment Reduction


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Financial Disclosure

Modifiers

Surgical Procedures

ICD-10-CM Transition


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PQRS and

E-Prescribing

Bonus or Penalty?

The Choice is Yours.


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PQRS Incentives and Penalties

VBP ‘09 ‘10 ‘11 ‘12 ‘13 ‘14 ‘15 ‘16 ‘17 ‘18

PQRS (Successful Participation)

2 2 1 .5 .5 .5

(Not Successful)

-1.5 -2 -2 -2


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PQRS 2013

In order to receive 0.5% of all your Medicare Part B,

Medicare as a secondary payer, and

Railroad Medicare allowables (less DME or any injectable drug) . . .


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PQRS 2013 Reporting Options

Option 1:

Report 3 measures correctly 50% of the time via claims (office reporting), or

Option 2:

Report 3 measures correctly 80% of the time via CMS approve registry.


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PQRS 2013

Physicians who fail to participate in

2013 will be subject to a 1.5 percent

payment adjustment in 2015.

• Participating means attempting to report

at least one PQRS measure between

Jan. 1 – Dec. 31, 2013.


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PQRS 2013

Minor changes to current measure

specifications.

• Glaucoma staging codes removed from

measures 12 and 141.

• Measure 124: Health Information

Technology has been eliminated.


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PQRS 2013

Reporting period January 1 through

December 31, 2013 if reporting three

measures via claims or registry.


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15 Ophthalmic Measures

Measure 12

Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Measure 14

Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Measure 18

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Measure 19

Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care

PQRS Measures


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15 Ophthalmic Measures Measure

117 Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient

Measure 130

Documentation of Current Medications in the Medical Record

Measure 137

Melanoma: Continuity of Care – Recall System Registry Only

Measure 138

Melanoma: Coordination of Care Registry Only

PQRS Measures


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15 Ophthalmic Measures Measure

140 Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement

Measure 141

Primary Open-Angle Glaucoma (POAG); Reduction of Intraocular Pressure (IOP) by 15 percent or Documentation of a Plan of Care

PQRS Measures


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Measure 191

Cataracts: 20/40 or Better Visual Acuity within 90 Days following Cataract Surgery Registry reporting only

Measure 192

Cataracts: Complications within 30 Days Following Cataract Surgery Requiring additional Surgical Procedures Registry reporting only

PQRS Measures


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Measure 224

Melanoma: Overutilization of Imaging Studies in Melanoma Registry reporting only

Measure 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Measure 265

Biopsy Follow-Up Registry reporting only

Note: All individual measures other than 137, 138, 191, 192, 224, and 265 can be reported via claims or registry.

PQRS Measures


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PQRS: Getting Started

Note: If a patient encounter qualifies

for more than one of the measures

you have selected, report on all that

qualify.


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PQRS 2013

Reminder:

• Not everyone in the practice has to

select the same measures.

• Nor does everyone in the practice need

to participate.


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PQRS 2013

Reminder:

• Reporting is based on the individual

NPI.

• Only those patients treated by that

physician will count towards the bonus

incentive.


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PQRS 2013

Reminder:

• The more participating physicians in the

practice –

◦ The greater the total bonus; and

◦ The greater your ability to avoid the 1.5%

payment adjustment.


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PQRS 2013

Important!

• Make sure your RA has C096 or N365

to verify that the measures have been

reported.

• If the claim is denied, the measure is

denied also and will have to be

resubmitted.


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PQRS

Visit www.aao.org/pqrs for all details

Questions? Email [email protected]

http://www.aao.org/pqrs

mailto:[email protected]


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VBP ‘09 ‘10 ‘11 ‘12 ‘13 ‘14 ‘15 ‘16 ‘17 ‘18

“E”RX (Successful Participation)

2 2 1 1 .5

(Not Successful) -1 -1.5 -2

E-Prescribing Incentives and Penalties


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New: Achieved meaningful use

sometime between Jan. 1, 2011

and June 30, 2012.

New: Registered for the EHR

Incentive program and adopted

EHR between Jan. 2, 2012 and

Jan. 31, 2013.

2013 Automatic Exemptions to E-Prescribing Penalties


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Otherwise

Report G8553 a minimum of 10

times from your office associated

with any billable service (exam,

test, surgery) with dates of service

between now and June 30, 2013, to

avoid the payment adjustment, or

E-Prescribing

Penalties/Payments


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Report G8553 a minimum of 25

times from your office associated

with an exam with dates of service

between now and June 30, 2013, to

receive the payment incentive.

E-Prescribing

Penalties/Payments


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PQRS 2013

Important!

• Make sure your RA has C096 or N365

to verify that the e-prescription has been

reported.

• If the claim is denied, G8553 is denied

also and will have to be resubmitted.


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PQRS 2013

Remember:

• Anything the pharmacy caries can

be e-prescribed.


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January 1, 2013 –

June 30, 2013

10 times to avoid the

2014 penalty – LAST

CHANCE!

Prescription can be

associated with any

Part B service; report

by claims only

CPT code 99024 is not

a reportable service

January 1, 2013 –

December 31, 2013

25 times to earn the

2013 incentive.

Prescription must be

associated with an

office visit; report by

claims or registry

2013/2014 E-Prescribing


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E-Prescribing Resources

Visit www.aao.org/e-rx for all details

Questions? Email [email protected]

http://www.aao.org/e-rx





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Questions ?


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E&M vs. Eye Codes


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Evaluation and Management

Eye Codes

Documentation requirements are nationally recognized by all payers.

Documentation requirements may vary by state and by payer.

No limitation on frequency for any payer.

No limitation on frequency for Medicare payers. Non-Medicare payers typically have frequency edits for comprehensive exams.

All diagnosis codes are covered. Limited diagnosis coverage list. Those typically covered can be found at www.aao.org/coding Many systemic disease diagnoses are not covered.

http://www.aao.org/coding


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E&M: History Component

Chief complaint

History of the present illness (HPI)

Review of systems (ROS)

Past, family, and social history

(PFSH)


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Chief complaint

• Does not have to be in the patient’s own

words

• Indicates what elements of the exam

should be performed

• Comprehensive = at least four elements


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HPI

Location: Right eye, left eye, both eyes?

Context: Associated with any activity?

Quality: Is the nature of the problem constant, acute, chronic, improved or worsening?

Modifying factors: What efforts have been made to improve the problem?

Severity: On a scale of 1-10 Mild, moderate, severe

Associated signs and symptoms: Is the problem causing blurred vision, twitching, headache?

Timing: Worse in am or pm? Onset?

Duration: How long has the issue been a problem?

Brief HPI 1-3 elements

Extended HPI 4-8 elements


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CC: 18-year-old female presents

with progressive field loss OD over

six weeks. Denies eye pain.


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ROS

Constitution Fever, weight loss, cancer

Eyes Sudden loss or change, distortion, double vision, itching, redness, discharge, swelling of lids

Ears, nose, mouth, throat Sinus infection, dry mouth, deafness

Cardiovascular High blood pressure, circulation problems, cholesterol treatment, heart attack

Respiratory Asthma, emphysema, TB


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ROS

Gastrointestinal Acid – Gerd, hepatitis

Musculoskeletal Arthritis

Neurological Stroke, MS, HOH

Endocrine Diabetes, thyroid

Hematologic/lymphatic Infection

Allergic/immunologic Seasonal allergies, hay fever


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ROS

Problem pertinent ROS

Only the system in the HPI is reviewed

Extended ROS Two to nine systems are reviewed

Complete ROS Ten or more systems are reviewed


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PFSH

Past history documentation may

include information regarding:

- Prior illnesses and injuries

- Prior operations

- Current medications

- Allergies


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PFSH

Family history documentation may include

information regarding:

• Disease of family member that may be

hereditary or place the patient at risk, such

as diabetes, amblyopia, retinal detachment,

AMD, and glaucoma

• Specific diseases related to problems

identified in the CC or HPI


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PFSH

Social history documentation should

include information regarding:

- Use of drugs, alcohol, and tobacco


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PFSH

Pertinent history

Only one of the three histories is documented

Complete All three of the histories are documented


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PFSH

All three of the histories must be present

for a new patient or a consultation for

those payers that still recognize those

codes.

Two of three histories must be present

for an established patient.


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PFSH

Information should be referenced

and updated at each visit.

• PFSH no change since (date).

• PFSH no change except__________

since (date).


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Exam • The following elements are

components of the eye examination.

Visual acuity Does not include determination of refractive error.

Gross visual field testing By confrontation

Ocular motility Including primary gaze alignment

Conjunctiva Bulbar and palpebral


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Exam

Ocular adnexa Lids, lacrimal gland, lacrimal drainage, orbits, preauricular nodes

Pupil and iris Shape, direct and consensual reaction (afferent pupil), size, shape, morphology

Cornea (slit-lamp) Epithelium, stroma, endothelium, and tear film

Anterior chamber (slit-lamp)

Depth, cells, flare

Lens (slit-lamp) Clarity, anterior & posterior capsule, cortex, nucleus


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Exam

Intraocular pressure Credit for performance of this element can be counted even when documentation states that IOP measurement has been deferred due to trauma, infection, or poor concentration, or contraindicated

Optic nerve discs Through dilated pupils, unless contraindicated, of size, C/D ratio, appearance such as atrophy, cupping, tumor elevation and nerve fiber layer

Posterior segment including retina and vessels

Through dilated pupils, unless contraindicated, exudates and hemorrhages, atrophy, detachments


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Exam

Brief assessment of mental status including:

Orientation to time, place and person

Mood and affect (eg, depression, anxiety, agitation)


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Exam

Which levels require dilated pupils?

New patient - 99204 and 99205

Established patient – 99215

- unless contraindicated.


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Number of Diagnosis and Management Options

Problem Categories Number Points Score

A B C D

Self limited or minor: stable, improved or worsening (Maximum of 2)

1

Established problem: stable or improved 1

Established problem; worsening 2

New problem: no additional work-up planned (Maximum of 1)

3

New problem: additional work-up planned 4

Total


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Number of Diagnosis and Management Options

If the score is 1, the number of

diagnostic/management options is minimal


diagnostic/management options is limited


diagnostic/management options is multiple

If the score is 4 or more, the number of

diagnostic/management options is extensive


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Amount and/or Complexity of Data

A Points B

Review and/or order of clinical lab tests 1

Review and/or order of radiology/ultrasound (CPT 70000 series or 92136)

1

Review and/or order of medical tests (CPT 90000 series) 1

Discussion of tests with performing physician 1

Independent review of image, tracing, and specimen 2

Decision to obtain old records and/or additional history from other than patient

1

Review of old records and/or additional history from other than patient

2

Total


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Amount and/or Complexity of Data

If the score is 1, the amount and/or complexity of data is minimal or low.

If the score is 2, the amount and/or complexity of data is limited.

If the score is 3, the amount and/or complexity of data is moderate.

If the score is 4 or more, the amount and/or complexity of data is extensive.


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Table of Risk

Using the Table of Risk determine the level of

risk for each:

- Presenting problem

- Diagnostic procedure

- Management options


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Level of Risk Presenting Problem(s)

Diagnostic Procedure(s)

Ordered

Management Options Selected

Minimal One self limited or minor problem – cold, insect bite

Lab tests X-rays EKG

Rest, Superficial dressings

Low Two or more self limited or minor problems One stable chronic illness (cataract, diabetes)

Skin biopsies Over the counter drugs Minor surgery with no identified risk factors


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Level of Risk

Presenting Problem(s) Diagnostic Procedure(s)

Ordered

Management Options Selected

Moderate One or more chronic illnesses with mild progression Two or more stable chronic illnesses Undiagnosed new problem Acute illness or complicated injury

Endoscopies Obtain fluid from body cavity

Minor surgery with identified risk factors Elective major surgery with no identified risk factors Prescription drug management.

High One or more chronic illnesses with severe progression or side effects of treatment. Acute or chronic illnesses or injuries that post threat to life or bodily function.

Diagnostic endoscopies with identified risk factors

Elective major surgery with risk factors Emergency major surgery


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Final Determination

New Patient – 3/3 components Comprehensive History Comprehensive Exam Moderate Medical Decision Making =

• 99204


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Final Determination

New Patient: 3/3 components Comprehensive History Comprehensive Exam High Medical Decision Making =

• 99205


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Final Determination

Established Patient: 2/3 components: Detailed History Detailed Exam Moderate Medical Decision Making =

• 99214


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Final Determination

Established Patient: 2/3 components: Comprehensive History Comprehensive Exam High Medical Decision Making =

• 99215


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CPT Published Examples

Initial visit for 55-year-old diabetic patient with progressive visual field loss, advanced optic disc cupping and neovascularization of retina.

99205


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CPT Published Examples

Initial visit for 29-year-old female with acute orbital congestion, eyelid retraction, and bilateral visual loss from optic neuropathy.

99205


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Levels of Service Defined

New Patient

99201

Usually the presenting problem(s) are self limited or minor and the physician typically spends 10 minutes face-to-face with the patient and/or family.

Problem focused history

Problem focused examination

Straightforward MDM

99202

Usually the presenting problem(s) are low to moderate severity and the physician typically spends 20 minutes face-to-face with the patient and/or family.

Expanded problem focused history

Expanded problem focused examination

Straightforward MDM


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New Patient

99203

Usually the presenting problem(s) are of moderate severity and the physician typically spends 30 minutes face-to-face with the patient and/or family.

Detailed history

Detailed examination

Low complexity MDM

99204

Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 45 minutes face-to-face with the patient and/or family.

Comprehensive history

Comprehensive examination

Moderate complexity MDM


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New Patient Established Patient

99205

Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 60 minutes face-to-face with the patient and/or family.



High complexity MDM

99211

Commonly referred to as “tech code”.

Usually the presenting problem(s) are minimal.

Typically 5 minutes are spent performing or supervising these services.


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Established Patient Established Patient

99212

Usually the presenting problem(s) are self limited or minor. Typically 10 minutes of physician face-to-face time with the patient and/or family.

Two of these three key components must be documented:

Problem focused history

Problem focused examination

Straightforward MDM

99213

Usually the presenting problem(s) are of low to moderate severity. Typically 15 minutes of physician face-to-face time with the patient and/or family.


Expanded problem focused history

Expanded problem focused examination

Low complexity MDM


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Established Patient Established Patient

99214

Usually the presenting problem(s) are moderate or high severity. Typically 25 minutes of physician face-to-face time with the patient and/or family.


Detailed history

Detailed examination

Moderate MDM

99215

Usually the presenting problem(s) are of moderate to high severity. Typically 40 minutes of physician face-to-face time with the patient and/or family.




High complexity MDM


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Time

When counseling and/or coordination of care constitutes more than 50% of the physician/patient and or family encounter, then time may be considered the key or controlling factor to qualify for a particular E&M service.

Documentation of time must be recorded in the medical record.


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Time

Chart notation might read:

- I spent _____ minutes with the patient. I spent more than half of that time providing counseling and coordination of care.


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Time

- I spent _____minutes with the patient. I spent

more than half of that time discussing the time

diagnosis and treatment.

- I spent _____ minutes with the patient. I spent

half of that time counseling about the

diagnosis and the importance of taking the

prescribed medication.


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Residents and Teaching Physicians

Both residents and teaching physicians may document services in the medical record.

The attending physician who bills Medicare for E&M services, must at a minimum, personally document:


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Residents and Teaching Physicians

- His/her participation in the management of the patient; and

- He/she performed the service or was physically present during the critical or key portions of the service performed by the resident.


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What About Consultations?

Even though CMS eliminated

consultation codes some commercial

payers recognize them.


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What About Consultations?

Two points to remember:

1. Is it really a request for an opinion (consult) or a transfer of care?

2. If Medicare is secondary payer, they will not pay the 20%.


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Questions


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Eye Code CPT Description

Intermediate Examination 92002 and 92012

Intermediate ophthalmological services describes an

evaluation of a new or existing condition complicated with

a new diagnostic or management problem not necessarily

relating to the primary diagnosis, including history, general

medical observation, external ocular and adnexal

examination, and other diagnostic procedures as

indicated; may include the use of mydriasis or

ophthalmoscopy.


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CPT Description

Intermediate Examination 92002 and 92012

Chief complaint

History

General medical observation

Visual acuity

External ocular exam

Adnexal exam

- May include use of mydriasis or ophthalmoscopy


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CPT Description

Comprehensive Examination 92004 and 92014

Comprehensive ophthalmological

services describe a general evaluation

of the complete visual system. The

comprehensive services constitute a

single service entity but need not be

performed in one session.


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CPT Description


The service includes history, general

medical observation, external and

ophthalmoscopic examination, gross

visual fields, and basic sensorimotor

examination.


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CPT Description


It often includes as indicated:

biomicroscopy examination with

cycloplegia or mydriasis and tonometry.

It always includes initiation of diagnostic

and treatment programs.


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CPT Description


Chief complaint

History

General medical observation

Visual acuity


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CPT Description


External ocular exam

Gross visual fields

Basic sensorimotor exam

Tonometry

Fundus exam (dilation as medically indicated)


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CPT Description

Comprehensive Examination 92004 and 92014 Initiation of diagnostic and treatment

program, which includes: - Prescription of medication - Arranging for special diagnostic or

treatment services - Consultations - Lab - Radiological services


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Questions


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E&M vs. Eye Codes

Bottom line:

Determine the appropriate level of

E&M code

Determine the appropriate level of

Eye code


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E&M vs. Eye Codes

Bottom line:

Bill the exam that has the highest

allowable for that payer.


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E&M vs. Eye Codes

Bottom line:

This means you need to obtain

the fee schedules for at least your

top five payers.


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E&M vs. Eye Codes

CPT code Commercial #1 Commercial #2 Medicare

99201 $80.46 $70 $39.74

99202 $138.57 $123.90 $68.74

99203 $201.90 $177.80 $99.17

99204 $313.65 $273.70 $152.58

99205 $393.36 $345.10 $190.30

92002 $106.82 $129.50 $72.96

92004 $200.02 $240.10 $135.74


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E&M vs. Eye Codes

CPT code Commercial #1 Commercial #2 Medicare

99211 $39.49 $37.80 $19.13

99212 $80.46 $72.10 $40.07

99213 $134.68 $119.70 $66.81

99214 $202.02 $179.90 $99.18

99215 $272.67 $240.10 $133.47

92012 $112.27 $136.50 $77.28

92014 $164.59 $197.40 $112.25


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Signature Log

Typed Name Legible signature Legible initials Title

John Q. Smith, MD John Q. Smith, MD JQS, MD Physician/MD

Sue J. Vicchrilli, COT Sue J. Vicchrilli,

COT

SJV, COT Certified Technician

Elizabeth Cottle, CPC, OCS

Elizabeth Cottle E.C. Administrator

Barbara Jones Barbara Jones BJ Receptionist


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Testing Services


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It’s All in the Details

1. CPT description

2. Linked diagnosis codes

3. Unilateral/bilateral distinction/modifiers

4. Delegation of tests

5. Interpretation and report


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6. Technical and professional

component

7. Which tests are bundled with other

tests? Is unbundling appropriate?

8. Advance Beneficiary Notice (ABN)


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What about frequency edits for

performance?

Unfortunately, rarely published.


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Frequency

If in doubt, obtain Advance Beneficiary Notice (ABN) from Medicare patients

Coding Resources (English and Spanish)

www.aao.org/coding

http://www.aao.org/coding


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Audits

Every auditor knows any test that

is delegated (not performed by

the physician) requires a written

order which should state:


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Audits

Which test

Which eye(s)

And the chart note should reflect

medical necessity.


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Audits

This must be documented in the medical record (not on the superbill or charge sheet).

Technicians may write the order as dictated by the physician. Physician signature required.


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Global Periods

When medically necessary, tests

may be billed (and paid), when

submitted within the global period

of a major or minor surgery.


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Testing Services – Skilled nursing facility

Difference between nursing home and

SNF

SNFs receive payment to rehabilitate

the patient.

The technical component of all special

testing services should be submitted to

the SNF and the professional

component to Part B Medicare.


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Physician Health Shortage Area

Identified by physician office zip code.

Additional payment for the technical

(-TC) paid on a quarterly basis.

No modifiers necessary.


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92081/92082/92083 Visual Fields

Documentation Unilateral Bilateral

TC 26

CCI Version 19.0

Note of performance and

findings

Bill once when testing one or both

eyes

Yes 92081: 99211, 92082, 92083

92082: 99211, 92083

92083: 99211


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92133 SCODI - Glaucoma


TC 26

CCI Version 19.0


findings

Bill once when

testing one or both

eyes

Yes 92132, 99211, 92134, 92227, 92250


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92134 SCODI - Retina


TC 26

CCI Version 19.0


findings

Bill once when

testing one or both

eyes

Yes 92132, 99211, 92227, 92250


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92250 Fundus Photography


TC 26

CCI Version 19.0


findings

Bill once when

testing one or both

eyes

Yes 99211, 92227


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92275 Electroretinography


TC 26

CCI Version 19.0


findings

Bill once when

testing one or both

eyes

Yes 99211


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Testing Services - MPPR

Fortunately, ophthalmology is late to

the reduction-of-payment-for-testing-

services game.

CMS initially applied this concept in

1995 to other specialties.


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CMS’ analysis of code pairs frequently

performed together revealed evidence of

duplicate payment for many activities.

For example, greeting the patient, taking

his or her history, and collating data were

not performed separately for each test,

but physicians were being paid as though

they were.


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When any of the following 27 testing

services are performed on the same

day, a 20 percent reduction will be

applied to the technical (-TC)

component of the lowest allowed

amount.


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76510 76516 92082 92136 92265 92285

76511 76519 92083 92228 92270 92286

76512 92025 92132 92235 92275

76513 92060 92133 92240 92283

76514 92081 92134 92250 92284


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Financial Impact - MPPR

CPT Code Total $ 2013 Professional $ 2013

Technical $ 2013

92250 Fundus Photo

$65.81 $22.60 $43.21

92134 OCT

$43.26 $27.72 $15.53

92083 Visual Field

$61.51 $27.11 $34.39


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Questions ?


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Modifiers


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Modifiers

When in a group practice with

surgical ophthalmologists,

global surgery rules impact

your coding.


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Unrelated E&M by same surgeon during postop period

Modifier -24


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Append the modifier to the unrelated office visit.

Management of a problem unrelated to the surgery or in the unoperated eye.

Requires a different diagnosis from the surgical diagnosis code.

Modifier -24


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Modifier -25

Significant, separately identifiable E&M (Eye code too) service by same physician the same day as a minor procedure


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Modifier -25

Append to the office visit.

To be used when a separately identifiable office visit and a minor surgical procedure are performed on the same day.


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26 – Professional component

To be used when the physician

completes only the professional

component of a testing service.

Append the modifier to the testing

service..


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Modifier -79

Unrelated procedure or service by

the same physician during the

postoperative period


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HCPCS modifiers

RT Right side

LT Left side

E1 Left upper lid

E2 Left lower lid

E3 Right upper lid

E4 Right lower lid


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GA ABN on file

GY Deny the claim

GW Patient enrolled in hospice

TC Technical component

HCPCS modifiers


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Questions ?


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Code This Case


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Surgery

CPT

Code

Description Global

Period

Physician

Allowable

37609 Ligation or biopsy

temporal artery

Zero-days $319 office

$212 facility

62270 Lumbar puncture Zero-days $137 office

$68 facility

64612 Chemodenervation

of muscle for

blepharospasm

Zero-days $121 office

$108 facility

95857 Myasthenia gravis Zero-days $51 office

$28 facility


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Modifier

When performed the same day as an exam – is it appropriate to append modifier -25 to the exam?

Is the exam significantly, separately identifiable from the minor surgical procedure performed on the same day?


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Questions ?


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ICD-9 ICD-10

ICD-10-CM


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ICD-10-CM


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Everyone who is covered by the

Health Insurance Portability and

Accountability Act (HIPAA) must

make the transition.

• Not just those who submit Medicare

or Medicaid claims.

ICD-10-CM


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ICD-9

446.5

Arteritis: Temporal, giant cell

ICD-10

M31.5

Giant cell arteritis with polymyalgia

rheumatica

M31.6 Other giant cell arteritis

ICD-10-CM


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ICD-9 333.81

Blepharospasm

ICD-10 G24.5

No other code

ICD-10-CM


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ICD-9 348.2Benign intracranial hypertension

ICD-10 G93.2

No other code

ICD-10-CM


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Visual field defect options:

H53.41 Scotoma involving central area

Central scotoma (not billable)

H53.411 Scotoma involving central

area, right eye


area, left eye


area, bilateral

ICD-10-CM


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Visual field defect options, cont.

H53.42 Scotoma of blind spot area

Enlarged blind spot (not a billable code)

H53.421 Scotoma of blind spot area,

right eye

H53.422 Scotoma of blind spot area,

left eye

H53.423 Scotoma of blind spot area, bilateral

- There are many more options.

ICD-10-CM


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What do you code?

• Retrobulbar optic neuritis

• Sudden visual loss

• Headache, tension, episodic, non

intractable

• H53.132, G44.209, H53.8

ICD-10-CM


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How to Get Started

Coders/Billers

• Run a diagnosis productivity report.

• Look up the most frequently diagnosis

codes you use now and convert them

to ICD-10.


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Headache R51

chronic daily R51

cluster G44.009

intractable G44.001

not intractable G44.009

daily chronic R51


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Headache R51

histamine G44.009

intractable G44.001


migraine (type) (see also Migraine)

G43.909

nasal septum R51

neuralgiform, short lasting


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Headache R51

unilateral, with conjunctival

injection and tearing (SUNCT)

G44.059

intractable G44.051



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Headache R51

short lasting unilateral neuralgiform,

with conjunctival

injection and tearing (SUNCT)

G44.059

intractable G44.051



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Headache R51

tension(-type) G44.209

chronic G44.229

intractable G44.221


episodic G44.219


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Headache R51

intractable G44.211


intractable G44.201



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How to Get Started

Coders/Billers

Three to six months prior to ICD-10

implementation

• Code every chart with ICD-10.

◦ Of course only actually submit ICD-9

code.


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How to Get Started

Do not waste time learning the

“tricks of the trade”

• Instead - learn the trade


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Conquering ICD-10 Resources

Website: www.aao.org/icd10

Questions may be emailed to

[email protected]

From those questions a library of

Q&A will be developed.

http://www.aao.org/icd10



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Questions ?


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