1. What is new in icd-10-cm 2017 Rebecca H Wartman OD
Heart of America Contact lens society
February 2017

2. Disclaimers for Presentation
All information was current at time it was prepared
Drawn from national policies, with links included in the presentation for your use
Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations
Prepared and presented carefully to ensure the information is accurate, current and relevant
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

3. Disclaimers for Presentation
Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services
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
The content of the COPE Accredited CE activity was prepared with assistance from Kara Webb (AOA Staff), Harvey Richman OD, and Doug Morrow OD

4. AOA Third Party Center Coding Experts
Rebecca Wartman OD
Douglas Morrow OD
Harvey Richman OD

5. 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

6. DO NOT FALL ASLEEP Too important - CMS leniency ended October 2016
Coding MUST be exact

7. Only part of ICD-10 we need
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
Only part of ICD-10 we need

8. 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

9. ICD-10-CM structure ICD-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

10. ICD-10-CM
Determine conditions for coding from medical documentation following ICD rules
Use Alphabetical Index to locate condition and allocate code
Use Tabular Listing to review all coding instructions related to code (e.g. inclusion, exclusion)
Use Instruction Manual for any rules regarding selection for reporting mortality/morbidity

11. Overview of ICD-10-CM Alphabetical Index
This is where you begin!
Can make errors if you do not start here!
Alphabetical list of codes from the Tabular List
-...
Alphabetical list of terms and corresponding code
Index of Diseases and Injury
Index of External Causes of Injury
Table of Neoplasms
Table of Drugs and Chemicals

12. Overview of ICD-10-CM Alphabetical Index
Helpful Hint
Syndromes under “syndrome” listing
Dry eye syndrome
Not under corneal
Not under lacrimal
Not under ocular
UNDER SYNDROME
Dysfunctions under “dysfunctions” listing
Degenerations under “degeneration” listing
Macular degeneration
Not under retinal
Not under macula
UNDER DEGENERATION

13. ICD-10-CM Terminology and Conventions Alphabetic Index Example
Macula
- cornea, corneal —see Opacity, cornea
- degeneration (atrophic) (exudative) (senile) —see also Degeneration, macula
- hereditary —see Dystrophy, retina
Degeneration, degenerative
- macula, macular (acquired) (age-related) (senile) H35.30
- - angioid streaks H35.33
- - atrophic age-related H35.31
- - congenital or hereditary —see Dystrophy, retina

14. ICD-10-CM Terminology and Conventions Tabular 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 code
Categories-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

15. ICD-10-CM Terminology and Conventions Tabular List
Category
Subcategory NOT a code
These are final codes
Subcategory that is Code

16. ICD-10-CM Terminology and Conventions 7th 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

17. ICD-10-CM Terminology and Conventions Includes Notes
Includes Notes: immediately under three character code title
further define or give examples of category content
Inclusion terms are list of terms included under some codes
Defines when code is to be used
May be synonyms of the code title
For “other specified” codes is list of various conditions assigned to code
BUT not necessarily exhaustive
Additional terms found only in Alphabetic Index may also be assigned to a code

18. ICD-10-CM Terminology and Conventions Excludes Notes
Pure excludes note- meaning “NOT CODED HERE!”
Excluded code should never be used at same time as code above Excludes1 note
Used when two conditions cannot occur together
(Example: congenital versus acquired form of same condition
Excludes2
Means “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

19. ICD-10-CM Terminology and Conventions Examples
Excludes 1 note
Excludes 2 note

20. 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

21. ICD-10-CM Terminology and Conventions Other Nomenclature
“Code also” note
Instructs that two codes may be required to fully describe condition, but this note does not provide sequencing direction
Default 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 condition
If condition is documented in medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned

22. We are ready to conquer this 2017 ICD-10-CM mountain!!

23. Changes to the Diabetes codes 2017
2016
New Wording
2017
More 2º codes
All DM patients on DM medication must use 2º code:
Z79.4 or Z79.84
Note: does not apply to E10 only

24. Changes to the Diabetes codes 2017
2016
NEW:
7th character
Per Eye
2017

25. Changes to the Diabetes codes 2017
2017 Diabetic coding changes are for all the categories
No medication code for Type 1 only

26. Changes to the Diabetes codes 2017
2016
2017
Long term Insulin use – No change
New code for oral DM medications
Both used when appropriate
In addition to DM diagnosis

27. Changes to the Diabetes codes 2017
2016
2017
Several other description were added to E11.35 subcategory.
HOWEVER
These changes were originally omitted from the initial recorded webinar

28. Changes to dry ARMD codes 2017
2016
2017
Beware:
7th character
Now per eye

29. Changes to Dry ARMD codes: Staging Dry ARMD
No AMD: >5 small (<63 microns) drusen
Mild AMD:
Multiple small drusen or some
intermediate ( 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 

30. Dry ARMD coding example : OD and OS
Advanced AMD OD
Intermediate AMD OD H
2 = OS
2 = Intermediate H
avclinic.com
Both codes necessary to describe patient
H and H
3 = Advanced
1 = OD

31. Changes to Wet ARMD codes 2017
2016
2017
BEWARE:
Similar change for Wet ARMD
7th character
Now per eye

32. Changes to Wet ARMD coding example
2 = OS H
1 = Active choroidal neo
1 = OD
retinagallery.com
3 = inactive scar
Both codes necessary to describe patient
H and H
webeye.ophth.uiowa.edu

33. Changes to glaucoma coding 2017
2016
2017
POAG now PER EYE!!
Staging remains the same

34. Changes to Glaucoma coding 2017
Code 1st No change
2016
2017
2017
Removed DM from Excludes1
Added an Excludes2 note for glaucoma in DM

35. Changes To CRVO codes 2017 2016 2017 NOTE!! 7th Character
Still Per Eye

36. CRVO Coding Example
1 = OD H
lifeinthefastlane.com
0 = With ME

37. CRVO Coding Example H34.8122 Well compensated CRVO 2 = OS 2 = Old CRVO
emedicine.medscape.com

38. Changes to BRVO Coding 2016 2017 Similar to CRVO New 7th Character
Still Per Eye

39. BRVO Coding Examples Left BRVO = H34.832 +7th H34.8320 H34.8322
0 = with ME H
2 = Stable, old
en.wikipedia.org
emedicine.medscape.com

40. Changes to Amblyopia Codes 2017
Brand new subcategory within Amblyopia

41. PostProcedural code changes 2017
2016
2017
ALL of these codes are per eye for 2016 and 2017 ONLY Subcategories listed here

42. Other Code changes of note 2017
2016
2017
Also for:
I69.11…
I69.21…
I69.31…
I69.81…
I69.91…

43. Other Code changes of note 2017
2016
2017
2016
2017

44. Other Code changes of note 2017
Chapter 20: Wording changes added some Excludes1 and Excludes2 codes
Review any of these codes used for changes from 2016

45. ICD-10-CM Resources American Optometric Association AOA Coding Today
AOA Coding Today
CDC ICD-10-CM Official USA site
2017 release of ICD-10-CM has all the downloads
CMS ICD-10-CM information
X World Health X but Use for general training only

46. Equip your office for ICD-10 changes
From AOA Marketplace
Preorder 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:
records-and-coding/icd-10

47. Success!! Happy Coding!!

48. QUESTIONS??? https://www.aoa.org/ask-the-coding-experts
Submit all ICD-10-CM questions and any coding questions to:

49. THANK YOU!!