1. My Vision Express presents An introduction to the new coding system ICD-10 Ready?

2.  5th digit specificity for certain codes.  Reporting two codes when required, instead of just one.  Combination codes (reporting one code for two conditions)  Coding for late effects  Reporting E codes, one for the injury, and one for the location of the injury.  Reporting E codes for adverse effects.  Screening V codes (V72.0) ICD-9 Guidelines

3. ICD-9 vs. ICD-10  ICD-9 has 13,000 codes compared to the new 68,000 ICD 10 codes.  Laterality as well as bilateral anatomy and disease codes have been added to the coding system.  ICD 9 codes have been merged to create one ICD 10 code.  Other ICD-9 codes have been split into two ICD-10 codes.

4. ICD-10 Format and Organization  ICD-10 consists of 3 to 7 characters. The first character is an alpha character, the second is numeric, and the rest can either be alpha or numeric.

5. ICD-10 Format and Organization ICD-10 consists of 3 to 7 characters. The first character is an alpha character, the second is numeric, and the rest can either be alpha or numeric. H00-H05 H10-H11 H15-H22 H25-H28 H30-H36 H40-H42 Disorders of the eyelid, lacrimal system, and orbit Disorders of the conjunctiva Disorders of the sclera, cornea, iris, and ciliary body Disorders of the lens Disorders of the choroid and retina Glaucoma

6. ICD-10 Format and Organization H43-H44 H46-H47 H49-H52 H53-H54 H55-H57 H59 Disorders of the vitreous body and globe Disorders of the optic nerve and visual pathways Disorders of ocular muscles, binocular movements, accommodation, and refraction Visual disturbances and blindness Other disorders of the eye and adnexa Intraoperative and post procedural complications and disorders of eye and adnexa, not elsewhere classified

7. Laterality  Report eye conditions by eye when applicable.  Certain codes such as Lid codes will contain upper and lower lid coding.  Other codes will have no laterality. XXX.XX1 = Right eye XXX.XX2 = Left Eye XXX.XX3 = Bilateral XXX.XX9 = Unspecified eye (not recommended) E08.321 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema E08.329 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema E08.321 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema E08.329 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema

8. Placeholder Codes  Certain codes will contain an “X” as a sixth-digit placeholder. This keeps the seventh character in the correct position.  Most common in injury and glaucoma codes.  If the placeholder is not included, it will result in an invalid code. ICD- 9 Code for Primary Open Glaucoma (POAG): 365.10 ICD- 9 Code for Primary Open Glaucoma (POAG): 365.10 ICD-10 Code for POAG: H40.11X0 POAG Stage Unspecified H40.11X1 POAG Mild Stage H40.11X2 POAG Moderate Stage H40.11X3 POAG Severe Stage H40.11X4 POAG Indeterminate Stage ICD-10 Code for POAG: H40.11X0 POAG Stage Unspecified H40.11X1 POAG Mild Stage H40.11X2 POAG Moderate Stage H40.11X3 POAG Severe Stage H40.11X4 POAG Indeterminate Stage

9. Occurrence Codes  Occurrence codes are included in injury codes along with placeholder codes.  Injury codes will have three different occurrence codes: Initial Subsequent Sequela ICD- 9 Code for Corneal foreign body: 930.0 ICD- 9 Code for Corneal foreign body: 930.0 ICD-10 Code for Foreign body in cornea: T15.00XA Foreign body in cornea, initial encounter T15.00XD Foreign body in cornea, subsequent encounter T15.00XS Foreign body in cornea, sequela ICD-10 Code for Foreign body in cornea: T15.00XA Foreign body in cornea, initial encounter T15.00XD Foreign body in cornea, subsequent encounter T15.00XS Foreign body in cornea, sequela

10. Initial Encounter  Initial encounters are not limited to the very first encounter for a new condition.  This can be used for multiple encounters as long as the patient receives active treatment for the condition.  Active Treatment: Initial evaluation of the condition. Surgical treatment Evaluation and continuing treatment by the same or a different physician.

11. Subsequent encounter  Subsequent encounters is after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.  Subsequent care: Cast change or removal, removal of external or internal fixation device, other aftercare and follow up visits following treatment of the injury or condition.

12. Sequela, Late Effect  Sequela are conditions that arise as a direct result of a condition (rust ring after a foreign body removal).  This is a condition produced after the acute phase of an illness of injury has terminated. A wound infection or an acute complication is not the same.  It is necessary to use the code that triggered the sequela (ex: foreign body removal) and the code for the sequela itself (rust ring). T15.01XA Foreign body in cornea, right eye, sequela

13. Exclude 1 Notes  Excludes 1: Indicates that code identified in the note and code where the note appears cannot be reports together because the 2 conditions cannot occur together. H40.021 Open angle with borderline findings, high risk Type 1 Excludes: H41.51- Absolute Glaucoma Q15.0 - Congenital Glaucoma P15.3 - Traumatic glaucoma due to birth injury Type 1 Excludes: H41.51- Absolute Glaucoma Q15.0 - Congenital Glaucoma P15.3 - Traumatic glaucoma due to birth injury

14. Exclude 2 Notes  Excludes 2: Indicates that condition identified in the note is not part of the condition represented by the code where the note appears, so both codes may be reported together if the patient had both conditions. H00.11 Chalazion, right upper eyelid Type 2 Excludes: S01.1- Open wound of eyelid S00.1-, S00.2- Superficial injury of eyelid Type 2 Excludes: S01.1- Open wound of eyelid S00.1-, S00.2- Superficial injury of eyelid

15. Refractive Codes  Each code will have four codes instead of one.  These codes should be used with 92015 and are not considered medical diagnosis.  Some medical insurance carriers may pay on medical diagnosis pointing to 92015. Exceptions: Presbyopia(No laterality) H52.1 Anisometropia(No laterality) H52.31 Aniseikonia (No laterality) H52.32 Exceptions: Presbyopia(No laterality) H52.1 Anisometropia(No laterality) H52.31 Aniseikonia (No laterality) H52.32 ICD-9 for Myopia: 367.1 ICD-9 for Myopia: 367.1 H52.11, Myopia, right eye H52.12, Myopia, left eye H52.13, Myopia, bilateral H52.19, Myopia, unspecified (not recommended) H52.11, Myopia, right eye H52.12, Myopia, left eye H52.13, Myopia, bilateral H52.19, Myopia, unspecified (not recommended)

16. Routine Eye Exam  V72.0, routine exam of eyes changes to two codes:  Z01.00 Encounter for examination of eyes and vision without abnormal findings.  Z01.01 Encounter for examination of eyes and vision with abnormal findings.  Individual carriers or vision plans may have different requirements.  Office visits should be linked to Z01.00 or Z01.01 when necessary.

17. Eyelid Codes  Seven codes are available for Eyelid codes. ICD-9 for Retained foreign body of eyelid is 374.86 H02.811 Retained foreign body in right upper eyelid H02.812 Retained foreign body in right lower eyelid H02.813 Retained foreign body in right eye, unspecified eyelid (not recommended) H02.814 Retained foreign body in left upper eyelid H02.815 Retained foreign body in left lower eyelid H02.816 Retained foreign body in left eye, unspecified eyelid (not recommended) H02.811 Retained foreign body in right upper eyelid H02.812 Retained foreign body in right lower eyelid H02.813 Retained foreign body in right eye, unspecified eyelid (not recommended) H02.814 Retained foreign body in left upper eyelid H02.815 Retained foreign body in left lower eyelid H02.816 Retained foreign body in left eye, unspecified eyelid (not recommended)

18. Injury Codes  When documenting injuries, include: Episode of Care Injury site Etiology Place of Occurrence S05.51XA Penetrating wound with foreign body of right eyeball, initial encounter S05.51XD Penetrating wound with foreign body of right eyeball, subsequent encounter S05.51XS Penetrating wound with foreign body of right eyeball, sequela S05.51XA Penetrating wound with foreign body of right eyeball, initial encounter S05.51XD Penetrating wound with foreign body of right eyeball, subsequent encounter S05.51XS Penetrating wound with foreign body of right eyeball, sequela

19. Injury Codes  Documentation components Chief complaint HPI (History of Present Illness) ROS (Review of Systems) PFSH (Patient, Family, Social History) Medical Decision Making

20. Lacrimal Gland Codes  Lacrimal codes follow the same guidelines as eyelid codes where they specify location. Dry eye syndrome 375.15 Dry eye syndrome 375.15 H04.121, Dry eye of right lacrimal gland H04.122, Dry eye of left lacrimal gland H04.123, Dry eye of bilateral lacrimal glands H04.129, Dry eye of unspecified lacrimal gland H04.121, Dry eye of right lacrimal gland H04.122, Dry eye of left lacrimal gland H04.123, Dry eye of bilateral lacrimal glands H04.129, Dry eye of unspecified lacrimal gland

21. Diabetic codes without manifestation 250.00 DM II, controlled 250.01 DM I, controlled E10.65 Type diabetes mellitus with hyperglycemia 250.02 DM II, uncontrolled 250.01 DM I, controlled E11.9 Type 2 diabetes mellitus without complications E10.9 Type 1 diabetes mellitus without complications E11.65 Type 2 diabetes mellitus with hyperglycemia

22. Diabetic Retinopathy  Two codes were needed when reporting ICD-9 diabetic retinopathy codes.  Diabetic codes in ICD-10 no longer need two reported. 250.51 Diabetes with ophthalmic manifestations, type I 362.04 Diabetic retinopathy: mild nonproliferative diabetic retinopathy E10.321 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E10.329 Type 1 diabetes mellitus with mild nonproflierative diabetic retinopathy without macular edema E10.321 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E10.329 Type 1 diabetes mellitus with mild nonproflierative diabetic retinopathy without macular edema

23. Claim Examples ICD 9 Example: Medical visit with Fundus Photos, Gonio, Pach, and Refraction.

24. Claim Examples ICD 10 Example: Medical visit with Fundus Photos, Gonio, Pach, and Refraction.

25. Post-Op Glasses Lens replaced by other means ICD9: V43.1 Lens replaced by other means ICD10: Z96.1 Presence of intraocular lens Lens replaced by other means ICD9: V43.1 Lens replaced by other means ICD10: Z96.1 Presence of intraocular lens Aphakia ICD9: 379.31 ICD10: H27.00 Aphakia unspecified H27.01 Aphakia, Right eye H27.02 Aphakia, Left eye H27.03 Aphakia, Bilateral Aphakia ICD9: 379.31 ICD10: H27.00 Aphakia unspecified H27.01 Aphakia, Right eye H27.02 Aphakia, Left eye H27.03 Aphakia, Bilateral Congenital Aphakia ICD9: 743.35 ICD10: Q12.3 Congenital Aphakia Congenital Aphakia ICD9: 743.35 ICD10: Q12.3 Congenital Aphakia

26. Post-Op Glasses

27. Questions? Is MVE ready for ICD-10? Yes. File > Setup> Company > System > Diagnosis will translate all ICD-9 codes to its 10 equivalent. Will ICD-10 replace CPT coding? The transition does not affect CPT coding for outpatient procedures and physician services. Who is affected? Health care providers and payers who do not do Medicare claims and anyone who is covered by HIPAA. Are both 9 and 10 codes needed during the transition? Only until all claims and other transactions for services before October 1, 2015, have been processed and completed. It is best to contact your clearinghouse and insurances you take for further information. What happens if I process claims with ICD-9 codes after October 1 st ? Claims that do not have the appropriate ICD-10 codes will not be processed. 1. 2. 3. 4. 5.

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