1. Excellence in Optometric Education John A. McGreal Jr., O.D. Missouri Eye Associates McGreal Educational Institute ICD-10-CM Workshop ICD-10-CM Workshop

2. JAM John A. McGreal Jr., O.D. McGreal Educational Institute ODExcellence Missouri Eye Associates n 11710 Old Ballas Rd. n St. Louis, MO. 63141 n 314.569.2020 n 314.569.1596 FAX n mcgrealjohn@gmail.com

3. JAM Understanding the Basics & Getting Ready n Putting ICD-10 into practice n How the ICD-10CM is laid out n How to Use the Alphabetic Index & Tabular List n How to Use the Index of injuries n How to Use the Table of Drugs & Chemicals n How to Use Placeholders n Understand laterality n How to Code for Diabetes & Glaucoma n How to use GEM files and Translators & ICD-10 manual

4. General Equivalence Mapping n No direct cross walk exist from version 9 to 10 n Mapping will greatly assist translation from version 9 n Eye code translation is fairly easy n EMR / PMS are creating bridges currently – ICD -9 to ICD-10 – ICD-10 to ICD-9 n No decimal points in GEM files n Single entry – in GEM file for which code in source system is linked to one code option in target system

5. GEM Flags – 3 Important Columns n Approximate Flag – attribute in a GEM file that when “turned on” (“0” changes to “1”) indicates entry is not equivalent n No Map Flag – attribute in a GEM file that when “turned on” indicates that a code in source system is not linked to a code in target system n Combination Flag – attribute in a GEM file that when “turned on” indicates that more than one code in target system is required n Forward Mapping – from old code set to new code set

6. General Equivalence Mapping Example n ICD9ICD10Flags n 36610H25900000 n 36611H258910000“1’ in first flag = approx n 36612H2509910000 n 36613H2503910000 n 36614H2504910000 n 36615H2501910000 n 36616H251010000 n 36617H258910000 n 36618H252010000

7. References for ICD Translation Help n www.aapc.com/icd-10/Codes/index.aspx for AAPC Code Translator www.aapc.com/icd-10/Codes/index.aspx n www.icd10data.com for free online translator www.icd10data.com n ICD-10 Transition & Training Edition – Pmiconline.com – 1.800.MEDSHOP

8. Case Studies for Clinical Correlation

9. JAM CASE 1: Cataract n CPT / ICD – 92015 / Myopia, bilateral (H52.13), astigmatism, regular (H52.223), Presbyopia (H52.4)= $20.00 – 99203 / Cataract, nuclear, bilateral (H25.13) = $100.00 or 92004 ($135) – Total $120.00 or + n Rx: Spectacles n RTO: 1YR n CPT / ICD – 92015 / Myopia (H52.13) = $20.00 – 99214 / Cataract (H25.13) = $100.00 or 92014 ($110) – Total $120.00 or +

10. JAM CASE 2: Blepharoconjunctivitis n CPT / ICD – 99213 or 92012 / Blepharoconjunctivitis, unspecified (H10.501) = $60.00 or $75.00 n Rx: Bacitracin Oint hs / Tobradex qid / Lid Hygiene / AFTs n RTO: 1 WK n CPT / ICD – 99212 / Blepharoconjunctivitis (H10.501) = $40.00 – Total $100.00 or $115

11. JAM CASE 3: Allergic Conjunctivitis n CPT / ICD – 99213 or 92012 / Acute atopic conjunctivitis, left (H10.12) – $60.00 or $75.00 n Rx: Pataday QD / Cold Packs / AFTs n RTO: 1 WK n CPT / ICD – 99212 or 92012 / Acute atopic conjunctivitis, left (H10.12) = $40.00 or $75.00 – Total $100.00 or $150.00

12. JAM CASE 4: Rosacea (Skin & Eye) n CPT / ICD – 99213 or 92012 Unspecified blepharitis, right upper eyelid (H10.001) / Rosacea, unspecified (L71.9) = $60.00 or $75.00 – 92285 / Marginal corneal ulcer, right (H16.041) = $25.00 – Total $ 85.00 or $100.00 n Rx: Zylet QID / Lid Hygiene (foams) / Doxycycline 50mg BID / MetroCream 0.75% BID RTO: 2 D n CPT / ICD – 99212 or 99213 / Unspec bleph, right upper eyelid (H16.041) = $40.00 or $75.00 – Total $125.00 or 175.00

13. JAM Case 5 : Conjunctival Foreign Body n CPT / ICD-9 = 930.1 – 65210 / Conj FB left eye (T15.12xA) = $65.00 – W31.1xxA Contact with metal working machines – Y92.015 Private garage of single family home – Y93.D3 Activity furniture building and repair – Total $65 n Rx: Acular QID / AFTs / Besivance TID n RTO: 1 Day / PRN

14. JAM CASE 6: Corneal Foreign Body n CPT / ICD = 930.1 – 65222 / Corneal Foreign Body, right eye (T15.01xA) = $70.00 – W29.3xxA Contact with powered garden & outdoor power tool – Y92.017 Garden or yard as place of occurrence single family house – Y93.H2 Pruning trimming shrubs – Total $70 n Rx: Acular LS QID / Zymar QID / Patch +/- Ibuprofen 400mg RTO: 1 Day

15. JAM CASE 7: Misdirected Lashes n CPT / ICD = 375.14 – 67820/ Trichiasis w/o entropion, left lower eyelid (H02.055) = $50.00 – Total $50 n Rx: Bromday qd / AFTs n RTO: 1 Day / PRN

16. JAM CASE 8: Corneal Erosion n CPT / ICD – 99213 / Recurrent Corneal Erosion, right eye (H18.831) = $60.00 – 92071 / Recurrent Corneal Erosion (H18.831) = $70.00 – Total $130.00 n Rx: Vigamox TID / Nevanac TID / Bandage SCL / Doxycycline 50mg qd optional / FreshKote TID n RTO: 1 Day n CPT / ICD – 99212 or 92012 / Recurrent Corneal Erosion (H18.831) = $40.00 or $75.00 – Total $170.00 or $205.00

17. JAM CASE 9: Bacterial Keratitis n CPT / ICD-9 370.03 – 99213 or 92012 / corneal ulcer, central, left (H16.012) = $60.00 or $75.00 – 92285 / (H16.012) = $25.00 – Total $85.00 or $100.00 n Rx: IQUIX q2h n RTO: 1 Day n E/M: 99212 or 99213 or…..? Can add anterior OCT – Total $145.00 and up

18. JAM CASE 10: Central Serous Retinopathy n CPT / ICD-9 363.71 – 99213 / Central serous retinopathy, left (H35.712) = $60.00 – 92225-LT / Central serous retinopathy (H35.712) = $20.00 – 92250 / Central serous retinopathy (H35.712) = $70.00 – Total $150.00 (Option to do OCT and use -59 on photo*) n Rx: Observation or Bromday qd RTO: 1 Mos n CPT / ICD – 99213 / Central serous retinopathy (H35.712) = $60.00 – 92226-LT / Central serous retinopathy (H35.712) = $20.00 – 92134 / Central serous retinopathy (H35.712) = $50.00 – Total $270.00

19. JAM CASE 11: Epiretinal Membrane n CPT / ICD 362.56 – 99214 / Macular puckering, left (H35.372) = $60.00 – 92225-LT / Macular puckering, left (H35.372) = $20.00 – 92250 / Macular puckering, left (H35.372) = $70.00 – Total $160.00 (Option to do OCT and use -59 on photo)* n Rx: Observation RTO: 1 Mos n CPT / ICD – 99213 / Macular puckering, left (H35.372) = $60.00 – 92226-LT / Macular puckering (H35.372) = $20.00 – 92134 / Macular puckering (H35.372) = $40.00 – Total $280.00

20. JAM CASE 12: Macular Degeneration/Dry n CPT / ICD-9 362.51 – 99203 / Age Related Macular Degeneration, non exudative (H35.31) = $100. – 92225-RT, 92225-LT / (H35.31) = $40.00 – 92250 / (362.51) = $70.00 – Total $210.00 n Rx: Amsler Grid (or PHP) / MPOD (cash) / Vitamins (Cash) / Genetic testing to set risk (Information and frequency issues) n RTO: 6 Mos or sooner n CPT / ICD – 99213 / 92134 / (H35.31) = $100.00 – Total $310.00 plus MPOD and Vitamins

21. JAM CASE 13: Macular Degeneration/Wet n CPT / ICD- 9 363.52 – 99203 / Age Related Macular Degeneration, exudative (H35.32), Problems related to lifestyle /Tobacco use NOS (Z72.0) = $100. – 92225-RT, 92225-LT / (H35.32) = $40.00 – 92250 / (H35.32) = $70.00 – Total $210.00 (Option for OCT use -59 on photo)* n Rx: Amsler Grid (or PHP or PHP Home) / MPOD (cash) / Vitamins / Consult Retina for IVFA and treatment n RTO: 6 Mos n CPT / ICD – 99213 / 92134 / 92082 (PHP) /(H35.32) = $150.00 – Total $360.00 insurance plus MPOD testing and Vitamin sales

22. JAM CASE 14: High Risk Medications n CPT / ICD – 99213 / Systemic lupus erythematosis w organ or system involvement (M32.1), Other long term current drug Treatment (Z79.899) = $60.00 – 92226-RT, 92226-LT / (M32.9, Z79.899) = $40.00 – 92083 / (M32.1, Z79.899) = $70.00 – 92134 / (M32.1, Z79.899) = $45 – Total $215.00 n Rx: Observation n RTO: 6 Mos n CPT / ICD – Same as above = $215.00 (some carriers allow SD-OCT once per year) – Total $430.00

23. JAM CASE 15: Dermatitis n CPT / ICD-9 373.32 – 99213 or 92012 / Allergic Dermatitis of upper eyelids, Right & left (H01.111, H01.114) = $60.00 or $75.00 – 92285 / (H01.111) = $25.00 – Total $85.00 or $100 n Hydrocortisone 1.0% QID / Cold Packs n RTO: 1 WK n CPT / ICD – 99212 / (H01.111) = $40.00 – Total $125.00 – $140.00

24. JAM CASE 16: Glaucoma Suspect n CPT / ICD-9 365.01 – 99214 / Glaucoma Suspect Low Risk, both eyes (H40.013) = $100.00 or 92014 ($110) – 92020 / (H40.013) = $25.00 – 76514 / (H40.013) = $15.00 – 92250 / (H40.013) = $70.00 – 92083 / (H40.013) = $80.00 n CPT / ICD – 99213 or 92012 / (H40.013) = $60.00 or $75.00 – 92133 / (H40.013) = $50.00 – Total $400.00 or $425.00 n Dx: Complete testing battery in two visits n Rx: Initiate or continue treatment or consultation-MD

25. JAM CASE 17: Neovascular glaucoma n CPT / ICD – 92012 / Glaucoma secondary to other eye disorders, left (H40.52 / Severe stage H40.52x3) = $75.00 – 92132 / goniosynechia (H40.52x3) = $35.00 – Total $108.00 n Rx: Combigan BID OS, PredForte BID OS n RTO: 1 WK n E/M: 99213 or….plus gonioscopy.? – Total $170.00 and up

26. JAM CASE 18: Punctal Occlusion of Dry Eye n Dx: Documentation: Narrative & Shirmer Strips n CPT / ICD Temporary Collagen Plugs ICD-9 375.15 – 99214-25 / Dry Eye Syndrome of bilateral lacrimal glands (H04.123) = $100.00 – 68761-E2 / (H04.123) = $135.00 – 68761-E4 / (H04.123) = $135.00 (Paid at 50% allowable) – Total $300.00 n E/M: Permanent Silicone Plugs – 99212-25, 68761-E2, 68761-E4 / (H04.123) = $240.00 n RTO: >10 Days After Permanent Punctal Occlusion n Total $540.00

27. JAM CASE 19: Cataract Co-Management n CPT / ICD-9 366.16 – 66984-55, RT or LT / Age related cataract nuclear (H25.11 (right) or H25.12 (left)) – Date of Service-is date of surgery – Range Dates-starts on date of transfer of care from MD to OD, ends 90 days from date of surgery – MD name and NPI n Rx: Post-Operative Care n RTO: Outcome dependent n E/M: 92015 and Material/Hardware Codes (DME)

28. JAM CASE 20: Sign & Symptom Coding n CC: eye pain / OU / mild / intermittent / 2 mos n CPT / ICD 9 368.1 – 99203 / H57.10 Ocular pain, unspecified eye, H53.10 Unspecified subjective visual disturbances n If diagnosis not determined, can use sign / symptom code

29. JAM CASE 21: Secondary Cataract n CPT: 99214 / ICD 9 366.53 n ICD: H26.492Other secondary cataract, left eye n ICD: Z98.42Cataract extraction status, OS n ICD: Z96.1 Presence of IOL n Rx: YAG capsulotomy, OS referral n Total $125

30. JAM CASE 22: Diabetes w/o Retinopathy n New diagnosis type 2 DM, stable BG n CPT / ICD 250.00 – 99214 / Type 2 DM w/o retinopathy (E11.9) n Rx: Monitor, letter PCP n RTO: 1 year n Total $125

31. JAM CASE 23: Diabetes with Retinopathy n DM x 6 years, Type 2, with background retinopathy OU n CPT / ICD 9 362.03 – 99214 / Type 2 DM with mild NPDR, w/o macular edema (E11.329) n Rx: Monitor, OCT order, letter PCP n RTO: 4-6 mos n Total $125

32. JAM CASE 24: Diabetes with Retinopathy n DM x 22 years, Type 2, with proliferative retinopathy OU, poor control of BG, use of insulin for 2 years n CPT / ICD 9 362.02 – 99214 / Type 2 DM with PDR, w/o macular edema (E11.359), Z79.4 Long term (current) use of insulin n Rx: OCT order, Photo/IVFA order, letter PCP, retina consult n RTO: stable n Total $125, plus testing

33. Monitor Compliance with Audits n Develop an “ICD-10 ” team n Get GEM file download n Get ICD-10 translator app n Get ICD-10 book n Get EMR software updates n Practice!! n Acknowledge positive & negative variances – RETRAIN, RETRAIN..

34. Thank you Excellence in Optometric Education Missouri Eye Associates McGreal Educational Institute Missouri Eye Associates McGreal Educational Institute