ICD-10-CM CHANGES

The proliferation of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for 2017 is especially relevant for retina practices, particularly the codes found in Chapter 4.1 New diagnosis codes should be in use now (started October 1), and the Centers for Medicare and Medicaid Services (CMS) has stated that they should be used from October 1 through September 30, 2017. Codes that do not change will continue to be used going forward.

CMS was lenient in 2016 in allowing the use of codes with the description unspecified. In ICD-10-CM jargon, unspecified means the laterality or specificity of the diagnosis was not noted in the chart, not that it is unspecified clinically. Practices can expect claim denials if unspecified codes continue to be used.

Codes that are more helpful are now in the book, but they are not necessarily where you would expect to find them. For example, codes for combined traction and rhegmatogenous retinal detachments can be found in Chapter 4 (Endocrine, Nutritional and other Metabolic Diseases) under diabetes, not in Chapter 7 (Diseases of the Eye and Adnexa). Chapter 4 also contains codes for use when a disease process has been treated and for disease that is stable. It is important for all physicians in a practice to review these changes because billing, coding, and payment will depend on the necessary information being documented in the chart.

GUIDELINES

The following is not a comprehensive list of all the changes for this year. Practices are advised to purchase and review the 2017 book.1

  • Diabetes mellitus has been abbreviated as DM.
  • All descriptors have been abbreviated.
  • Indented codes on this list are read with the beginning descriptor of the prior code.
  • The hyphen (-) at the end of a code signifies that another digit is mandatory in order for the code to be valid. This is a 7th character that must be used.
  • The codes to be added in this version are the location designations: 1 = right eye, 2= left eye, 3 = bilateral,
    9 = unspecified eye. The term unspecified in ICD-10-CM coding means that the eye was not specified in the chart.

Examples:

  • EO83211 DM with mild nonproliferative retinopathy with macular edema, right eye
  • H35.3121 Nonexudative age-related macular degeneration, left eye, dry stage
  • H35.3231 Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization

Chapter 4: Endocrine, Nutritional, and Other Metabolic Diseases

7th Characters

One of the following 7th characters to be assigned to codes in the subcategories below to designate laterality of the disease

1 right eye

2 left eye

3 bilateral

9 unspecified

Use in subcategories
E08.32, E08.33, E08.34, E08.35, and E08.37

Use in subcategories
E09.32, E09.33, E09.34, E09.35, and E09.37

Use in subcategories
E10.32, E10.33, E10.34, E10.35, and E10.37

Use in subcategories
E11.32, E11.33, E11.34, E11.35, and E11.37

E08.319 DM with unspecified diabetic retinopathy without macular edema

E08.321- DM with mild nonproliferative diabetic retinopathy with macular edema

E08.329- without macular edema

E08.331- DM with moderate nonproliferative diabetic retinopathy with macular edema

E08.339- without macular edema

E08.341- DM with severe nonproliferative diabetic retinopathy with macular edema

E08.349- without macular edema

E08.351- DM with proliferative diabetic retinopathy with macular edema

E08.353- DM with proliferative diabetic retinopathy with traction retinal detachment not involving the macula

E08.354- DM with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment

E08.355- DM with stable proliferative diabetic retinopathy

E08.359- DM with proliferative diabetic retinopathy without macular edema

E08.36 DM with diabetic cataract

E08.37X- DM with diabetic macular edema, resolved following treatment

E08.39 DM with other diabetic ophthalmic complication

E09311- Drug or chemical induced DM with unspecified diabetic retinopathy with macular edema

E09.31- without macular edema

E09321- Drug or chemical induced DM with mild nonproliferative diabetic retinopathy with macular edema

E09.329- without macular edema

E09.331- Drug or chemical induced DM with moderate nonproliferative diabetic retinopathy with macular edema

E09.339- without macular edema

E09.341- Drug or chemical induced DM with severe nonproliferative diabetic retinopathy with macular edema

E09.349- without macular edema

E09.352- Drug or chemical induced DM with proliferative
diabetic retinopathy with traction retinal detachment involving the macula

E09.353- with traction retinal detachment not involving the macula

E09.354- Drug or chemical induced DM with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment

E09.355- Drug or chemical induced DM with stable proliferative diabetic retinopathy

E09.359- Drug or chemical induced DM with proliferative diabetic retinopathy without macular edema

E09.36 Drug or chemical induced DM with diabetic cataract

E09.37X- Drug or chemical induced DM with diabetic macular edema, resolved following treatment

E09.39 Drug or chemical induced DM with other diabetic ophthalmic complication

E10.311 Type 1 DM with unspecified diabetic retinopathy with macular edema

E10.319 without macular edema

E10.321- Type 1 DM with mild nonproliferative diabetic retinopathy with macular edema

E10.329- without macular edema

E10.331- Type 1 DM with moderate nonproliferative diabetic retinopathy with macular edema

E10.339- without macular edema

E10.341- Type 1 DM with severe nonproliferative
diabetic retinopathy with macular edema

E10.349- without macular edema

E10.351- Type 1 DM with proliferative diabetic retinopathy with macular edema

E10.352- Type 1 DM with proliferative diabetic retinopathy with traction retinal detachment involving the macula

E10.353- not involving the macula

E10.354- Type 1 DM with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment

E10.355- Type 1 DM with stable proliferative diabetic retinopathy

E10.359- Type 1 DM with proliferative diabetic retinopathy without macular edema

E10.36 Type 1 DM with diabetic cataract

E10.37X- Type 1 DM with diabetic macular edema, resolved following treatment

E10.39 Type 1 DM with other diabetic ophthalmic complication

E11.311 Type 2 DM with unspecified diabetic retinopathy with macular edema

E11.319 without macular edema

E11.321- Type 2 DM with mild nonproliferative diabetic retinopathy with macular edema

E11.329- without macular edema

E11.331- Type 2 DM with moderate nonproliferative diabetic retinopathy with macular edema

E11.339- without macular edema

E11.341- Type 2 DM with severe nonproliferative diabetic retinopathy with macular edema

E11.349- Type 2 DM with severe nonproliferative diabetic retinopathy without macular edema

E11.351- Type 2 DM with proliferative diabetic retinopathy with macular edema

E11.352- Type 2 DM with proliferative diabetic retinopathy with traction retinal detachment involving the macula

E11.353- not involving the macula

E11.354- Type 2 DM with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment

E11.355- Type 2 DM with stable proliferative diabetic retinopathy

E11.359- Type 2 DM with proliferative diabetic retinopathy without macular edema

E11.36 Type 2 DM with diabetic cataract

E11.37X- Type 2 DM with diabetic macular edema, resolved following treatment

E11.39 Type 2 DM with other diabetic ophthalmic complication

Chapter 7: Diseases of the Eyes and Adnexa

H34.81 Central retinal vein occlusion

One of the following 7th characters is to be assigned to codes in subcategory H34.81 to designate the severity of the occlusion.

0 with macular edema

1 with retinal neovascularization

2 stable

Old central retinal vein occlusion

H34.83 Tributary (branch) retinal vein occlusion

One of the following 7th characters is to be assigned to codes in subcategory H34.83 to designate the severity of the occlusion.

0 with macular edema

1 with retinal neovascularization

2 stable

Old tributary (branch) retinal vein occlusion

H35.31 Nonexudative age-related macular degeneration; dry age-related macular degeneration

H35.311- Nonexudative age-related macular degeneration, right eye

H35.312- Nonexudative age-related macular degeneration, left eye

H35.313- Nonexudative age-related macular degeneration, bilateral

H35.319- Nonexudative age-related macular degeneration, unspecified eye

H35.32 Exudative age-related macular degeneration; wet age-related macular degeneration

One of the following 7th characters is to be assigned to codes in subcategory H35.32 to designate the stage of the disease.

0 stage unspecified

1 with active choroidal neovascularization

2 with inactive choroidal neovascularization with involuted or regressed neovascularization

3 advanced atrophic without subfoveal involvement advanced dry stage

H35.321- Exudative age-related macular degeneration, right eye

H35.322- Exudative age-related macular degeneration, left eye

H35.323- Exudative age-related macular degeneration, bilateral

H35.329- Exudative age-related macular degeneration, unspecified eye

Chapter 2: Neoplasms

C69.2- Malignant neoplasm of retina

C69.3- Malignant neoplasm of choroid

C69.4- Malignant neoplasm of ciliary body

CPT CHANGES

Although there are only a few Current Procedural Terminology (CPT) Category I code changes for 2017, they are important (Table).2 For codes 67101 and 67105, “one or more sessions” was deleted from the descriptor, and the global period was changed from 90 to 10 days. This means that repeat procedures can be billed after 11 days. This also means that the procedures are now considered minor surgery; thus, caution is warranted when using modifier 25 in order to obtain reimbursement for the office visit in these established patients.3

The National Correct Coding Initiative bundles will be published in January 2017, and the new and revised codes should be checked for new code-pair edits.

Fluorescein angiography and indocyanine green angiography have had a status change from a unilateral procedure (payment for each side) to a bilateral procedure (payment is the same for one or both sides). n

 

1. ICD-10-CM 2017: The Complete Official Codebook. Chicago, IL: American Medical Association; 2017.

2. CPT 2016 Professional Edition. Chicago, IL: American Medical Association; 2016.

3. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Global Surgery Fact Sheet. March 2015. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1256840.html. Accessed October 24, 2016.

 

Riva Lee Asbell
• principal, Riva Lee Asbell Associates, in Fort Lauderdale, Fla.
• financial interest: none acknowledged
• rivalee@rivaleeasbell.com
CPT codes copyright 2015 American Medical Association