WHAT IS NEW IN ICD‐10‐CM2017

REBECCA H WARTMAN OD

NORTH CAROLINA OPTOMETRIC SOCIETY 

NOVEMBER 2016

DISCLAIMERS FOR PRESENTATION1.All information was current at time it was prepared2.Drawn from national policies, with links included in the

presentation for your use3.Prepared as a tool to assist doctors and staff and is not

intended to grant rights or impose obligations4.Prepared and presented carefully to ensure the

information is accurate, current and relevant 5.No conflicts of interest exist for presenters- financial or

otherwise. However, Rebecca is a paid consultant for Eye Care Center OD PA and writes articles

DISCLAIMERS FOR PRESENTATION6. Of course the ultimate responsibility for the correct submission of

claims and compliance with provider contracts lies with the provider of services

7. AOA, AOA-TPC, NCOS, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein

8. The content of the COPE Accredited CE activity was prepared with assistance from Kara Webb (AOA Staff), Harvey Richman OD, and Doug Morrow OD

AOA THIRD PARTY CENTER CODING EXPERTS

Rebecca Wartman OD Douglas Morrow OD Harvey Richman OD

WHAT WE WILL COVER

• Overview of ICD‐10‐CM 

• Review of important definitions

• Updates for 2017

• Diabetes Codes

• ARMD Codes

• Glaucoma Codes

• Suggested approaches for review of 2017 changes

• New Resources of 2017

DO NOT FALL ASLEEP

Too important  ‐ CMS leniency ended October 2016

Coding MUST be exact

OVERVIEW OF ICD‐10‐CM

1st

• ICD‐10‐CM/PCS• (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) 

2nd• ICD‐10‐CM for diagnosis coding • ICD‐10‐PCS for inpatient procedure coding (Hospitals only)

3rd• ICD‐10‐CM replaces ICD‐9‐CM• Does not change use of CPT®  in any way

US VERSION OF ICD-10-CM NOT WORLD HEALTH VERSION

ICD-10-CM owned by World Health Organization BUT ICD-10-CM code set for use in the United States is

maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC)

Thus some different rules will apply for US vs World Health Organization versions of code set

www.cdc.gov/nchs/icd/icd10cm.htm

ICD-10-CM STRUCTUREICD‐10‐CM =68,000 +

3 ‐7 characters

Character 1= alpha (except U)

Character 2 = numbers

Characters 3‐7=alpha or #

Decimal after 3 characters

ICD‐10:Dummy placeholder “x” used when need 7th character

Alpha characters not case‐sensitive

ICD-10-CM TERMINOLOGY AND CONVENTIONSTABULAR LIST Tabular list →chapters ►body system/condition 

Divided into categories, subcategories and codes Can ONLY report codes

• If has no further subdivision is equivalent to codeCategories‐3 characters

• Each level of subdivision after a category is a subcategory

• If no further subdivision is equivalent to a code

Subcategories ‐ 4 or 5 characters

• Final level of subdivision 

• If 7th character is required invalid without 7th character

• If placeholder needed‐X used for code to be valid code

Codes‐ 3, 4, 5, 6 or 7 characters 

ICD-10-CM TERMINOLOGY AND CONVENTIONSTABULAR LIST

These are final codes

Subcategory NOT a code

Subcategory that is Code

Category

ICD-10-CM TERMINOLOGY AND CONVENTIONS7TH CHARACTERS

If code requires 7th character but is not 6 characters long THEN must use placeholder X to fill in empty characters

The 7th character must be 7th character in data field

When 7th character is required →used for all codes within  category or as noted in Tabular List instructions

Certain ICD‐10‐CM categories need 7th character

ICD-10-CM TERMINOLOGY AND CONVENTIONSEXCLUDES NOTESExcludes1

Pure excludes note- meaning “NOT CODED HERE!” Excluded code should never be used at same time as code above Excludes1 noteUsed when two conditions cannot occur together(Example: congenital versus acquired form of same condition

Excludes2Means “Not included here”Excluded condition is not part of condition represented by code,BUT patient may have both conditions at the same time

Excludes2 code acceptable to use when both the code and excluded code occur together

ICD-10-CM TERMINOLOGY AND CONVENTIONSEXAMPLES

Excludes 1 note

Excludes 2 note

ICD-10-CM SEQUENCING ORDER TABULAR NOTES

• “In diseases classified elsewhere” codes:• Never permitted to be used as first-listed diagnosis code• Must be used with underlying condition code• Must be listed following the underlying condition

• Some manifestation codes do not have “in diseases classified elsewhere” in title• “use additional code” note for the etiology code• “code first” note at the manifestation code• Rules for sequencing apply→

etiology code then manifestation code

ICD-10-CM TERMINOLOGY AND CONVENTIONSOTHER NOMENCLATURE“Code also” noteInstructs that two codes may be required to fully describe condition, but this note

does not provide sequencing directionDefault codes Listed next to a main term in Alphabetic Index The default code represents condition most commonly associated with main term or

is the unspecified code for the conditionIf condition is documented in medical record (for example, appendicitis) without any

additional information, such as acute or chronic, the default code should be assigned

WE ARE READY TO CONQUER THIS 2017 ICD‐10‐CM MOUNTAIN!!

CHANGES TO THE DIABETES CODES 2017

All DM patients on DM medication must use 2º code: 

Z79.4 or Z79.84Note: does not apply to E10 only

CHANGES TO THE DIABETES CODES 2017

2016

NEW:7th character

Per Eye2017

2017 Diabetic coding changes are for all the categories

CHANGES TO THE DIABETES CODES 2017

No medication code for Type 1 only

CHANGES TO THE DIABETES CODES 20172016

2017

New code for oral DM medications

Long term Insulin use – No change

Both used when appropriateIn addition to DM diagnosis 

CHANGES TO THE DIABETES CODES 2017

2016

Several other description were added to E11.35 subcategory.HOWEVER

These changes were originally omitted from the initial 

recorded webinar

CHANGES TO DRY ARMD CODES 20172016

Beware:7th character Now per eye

CHANGES TO DRY ARMD CODES: STAGING DRY ARMDNo AMD: >5 small (<63 microns) drusen

Mild AMD: 

Multiple small drusen or some

intermediate (63‐124 microns) drusen

Intermediate AMD: 

Extensive intermediate drusen, >1 large

(>125 microns) drusen, or

non‐central geographic atrophy

Advanced AMD: 

Central geographic atrophy or

neovascularization causing vision loss

(<20/32) in one eye

www.retinalphysician.com

DRY ARMD CODING EXAMPLE : OD AND OS

1 = OD

2 = Intermediate

Intermediate AMD OD

2 = OS

3 = Advanced Both codes necessary to describe patientH35.3113 and H35.3122

H35.3113

H35.3122

www.goodhopeeyeclinic.org.uk

avclinic.com

Advanced AMD OD

CHANGES TO WET ARMD CODES 20172016

BEWARE:Similar change for Wet ARMD

7th character Now per eye

CHANGES TO WET ARMD CODING EXAMPLE

Both codes necessary to describe patientH35.3213 and H35.3221

webeye.ophth.uiowa.edu

H35.3221

2 = OS

1 = Active choroidal neoH35.3213

1 = OD

3 = inactive scarretinagallery.com

CHANGES TO GLAUCOMA CODING 2017

2016

2017

POAG now PER EYE!!Staging remains the same

CHANGES TO GLAUCOMA CODING 2017

Code 1st No change

Removed DM from Excludes1 Added an Excludes2 note for glaucoma in DM

CHANGES TO CRVO CODES 2017

2017

2016

NOTE!!7th Character Still Per Eye

CRVO CODING EXAMPLE

H34.8110

1 = OD

0 = With MElifeinthefastlane.com

CRVO CODING EXAMPLE

Well compensated CRVO 

H34.8122

2 = OS

2 = Old CRVO

emedicine.medscape.com

CHANGES TO BRVO CODING

2017

2016

Similar to CRVONew 7th Character 

Still Per Eye

BRVO CODING EXAMPLES

en.wikipedia.orgemedicine.medscape.com

H34.8320H34.8322

Left BRVO = H34.832 +7th

0 = with ME 

2 = Stable, old

CHANGES TO AMBLYOPIA CODES 2017

Brand new subcategory within Amblyopia

POSTPROCEDURAL CODE CHANGES 2017

ALL of these codes are per eye for 2016 and 2017 ONLY Subcategories listed here

2017

OTHER CODE CHANGES OF NOTE 20172016

2017

Also for:I69.11…I69.21…I69.31…I69.81…I69.91…

OTHER CODE CHANGES OF NOTE 20172016

2017

2016

OTHER CODE CHANGES OF NOTE 2017

Chapter 20: Wording changes added some Excludes1 and Excludes2 codesReview any of these codes used for changes from 2016 

ICD-10-CM RESOURCESAmerican Optometric Association www.aoa.org/coding

AOA Coding Todayhttp://aoa.codingtoday.com/

CDC ICD‐10‐CM Official USA sitehttp://www.cdc.gov/nchs/icd/icd10cm.htm2017 release of ICD‐10‐CM has all the downloads

CMS ICD‐10‐CM informationhttps://www.cms.gov/Medicare/Coding/ICD10/index.html

X World Health X but Use for general training onlyhttp://apps.who.int/classifications/apps/icd/icd10training

EQUIP YOUR OFFICE FOR ICD‐10 CHANGES• From AOA Marketplace

• Preorder  2017 AOA Coding Bundle ‐ available Sept. 15

• Includes:• 2017 AOA Codes for Optometry (ICD‐10)

• 2017 ICD‐10‐CM AOA Express Mapping Card (not sold separately)

• 2017 AMA CPT Professional Edition

• Additional ICD‐10 resources from AOA:

http://www.aoa.org/optometrists/tools‐and‐resources/medical‐records‐and‐coding/icd‐10

SUCCESS!!HAPPY CODING!!

QUESTIONS???

Submit all ICD‐10‐CM questions and any coding questions to:

https://www.aoa.org/ask‐the‐coding‐experts

THANK YOU!!