ICD-10-CM Are You Prepared? Part V Glaucoma-Optic Pathways

Rebecca H. Wartman OD May 2014

With contributions from Doug Morrow OD & Harvey Richman OD

Overview This webinar will provide an

introduction to ICD-10-CM coding changes and begin your preparation

There will be more information coming in the next few months to further prepare you for the change to ICD-10-CM

Are You Well Connected?? Notice: To hear the audio portion of this webinar- Connect through your computer with a headset or through your telephone

If you cannot get connected, you may contact Erin Nichols AOA TPC staff member, for assistance:

EMNichols@AOA.org

1.All information was current at time it was prepared 2.Drawn from national policies, with links included in

the presentation for your use 3.Prepared as a tool to assist doctors and staff and is

not intended to grant rights or impose obligations 4.Prepared and presented carefully to ensure the

information is accurate, current and relevant 5.No conflicts of interest exist for the presenter-

financial or otherwise

Disclaimers for Presentation

Disclaimers for Presentation

6. 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, 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

Recording and Handouts for this Course

Recorded presentation and webinar course handouts will be available at: http://www.aoa.org/coding

Click ICD-10 on the right hand column and it will

take you to all the available resources for ICD-10 Other helpful resources will soon be available as well

Q&A and After the Webinar • AT THE END OF THE PRESENTATION: Questions will be answered at the end of the

presentation, as time permits To ask a question that pertains to this presentation: Click on the red arrow to maximize the webinar

control panel and expand the ‘Questions’ section. Type inquiries in the dialog box and press ‘Send

• AFTER THE WEBINAR Please send questions to…

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

AOA Third Party Center Coding Experts

Rebecca H. Wartman, O.D Douglas C. Morrrow, O.D Harvey B. Richman, O.D

Outline for ICD-10-CM Webinars Are you prepared? 10 Part Series

January 10, 2014 Introduction to ICD-10-CM Coding System February 14,2014 ICD-10-CM More Basics March 21, 2014 ICD-10-CM Coding: Lids to Lens April 11,2014 ICD-10-CM Coding: Posterior Segment May 23,2014 ICD-10-CM Coding: Glaucoma-Optic Pathways June 20,2014 ICD-10-CM Coding: Refraction, Muscles, Disturbances July 11,2014 ICD-10-CM Coding: Diabetes and other systemic disease August 8, 2014 ICD-10-CM Coding: Common Ocular Infection and Injury September 5,2014 ICD-10-CM Coding: Post-procedural Complications October 3,2014 ICD-10-CM Coding: Odds and Ends and Recap

All are or will be recorded and posted to the AOA Eyelearn site within 3-5

business days after the original presentation

Topics for Tonight Glaucoma-Optic Pathways

• HUGE ICD-10-CM news • Brief Overview of Chapter 7 • Chapter 7 General Inclusions and Exclusions- Details • Chapter 7 Details • H40-H42 Glaucoma • H46-H47 Disorders of Optic Nerve and Visual Pathways • Questions • Resources • Self Assessment Review Questions

With specific coding examples sprinkled throughout presentation

ICD-10-CM News!! • Congress passes a one year delay in the implementation of ICD-10-CM • What does this mean?

• AOA is still pushing you to prepare for this change • Gives providers more time to prepare • TAKE THE TIME NOW TO LEARN THIS NEW SYSTEM • Breathing room for all involved • Still need to PREPARE

• New date October 1, 2015

H00-H05→Disorders of eyelid, lacrimal system, orbit H10-H11→Disorders of conjunctiva H15-H22→Disorders of sclera, cornea, iris, ciliary body H25-H28→Disorders of lens H30-H36→Disorders of choroid and retina H40-H42→Glaucoma H43-H44→Disorders of vitreous body and globe H46-H47→Disorders of optic nerve & visual pathways H49-H52→Disorders of ocular muscles, binocular

movement, accommodation and refraction H53-H54→Visual disturbances and blindness H55-H57→Other disorders of eye and adnexa H 59 →Intraoperative and postprocedural complications

and disorders

Tabular List Chapter 7 Categories (Slightly different list than in very first webinar- Official USA Version for ICD-10-CM)

Chapter 7 Diseases of the eye and adnexa (H00-H59) Overall Notes and Exclusions Note: Use an external cause code following the code for the eye

condition, if applicable, to identify the cause of the eye condition

Excludes2: Certain conditions originating in the perinatal period (P04-P96) Certain infectious and parasitic diseases (A00-B99) Complications of pregnancy, childbirth and the puerperium (O00-O9A) Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) Diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-) Endocrine, nutritional and metabolic diseases (E00-E88) Injury (trauma) of eye and orbit (S05.-) Injury, poisoning and certain other consequences of external causes (S00-T88) Neoplasms (C00-D49) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

(R00-R94) Syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)

Definition Reminder • Excludes1: Excludes 1 note is pure excludes note- meaning “NOT CODED HERE!” Code excluded should never be used at same time as code above Excludes1

note Excludes1 used when two conditions cannot occur together (Example: congenital versus acquired form of same condition)

• Excludes2 Excludes2 note 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 used when it is acceptable to use both code and excluded code

together, when applicable

Coding Guidelines for Glaucoma 1. Assigning Glaucoma Codes Assign as many codes from category H40, Glaucoma, necessary to identify a) type of glaucoma b) affected eye c) glaucoma stage

2. Bilateral glaucoma with same type and stage If code for bilateral glaucoma, report only bilateral code, with seventh

character for stage If no code for bilateral glaucoma, report only one code for type of glaucoma

with seventh character for stage

Coding Guidelines for Glaucoma 3. Bilateral glaucoma stage with different types or stages a) Each eye different type or stage, and the classification distinguishes

laterality= one code for each eye

b) Each eye different type, but classification does not distinguish laterality = one code for each type of glaucoma with seventh character for stage (subcategories H40.10, H40.11 and H40.20)

c) Each eye has same type, but different stage, and classification does not distinguish laterality =one code for type ,each eye plus seventh character for stage, each eye (subcategories H40.10, H40.11 and H40.20)

Coding Guidelines for Glaucoma 4. Indeterminate stage glaucoma

Assignment seventh character “4” for “indeterminate stage” based on clinical documentation

Seventh character “4” is used for glaucoma when stage cannot be clinically determined

This seventh character “0”, unspecified, which should be assigned when no documentation regarding stage of glaucoma

Glaucoma Alphabetical Index Long listing for different glaucoma: Glaucoma H40.9 - with - - increased episcleral venous pressure H40.81- - - pseudoexfoliation of lens —see Glaucoma, open angle, primary, capsular - absolute H44.51- - angle-closure (primary) H40.20- - - acute (attack) (crisis) H40.21- - - chronic H40.22- - - intermittent H40.23- - - residual stage H40.24- - borderline H40.00- - capsular (with pseudoexfoliation of lens) —see Glaucoma, open angle, primary, capsular - childhood Q15.0 - closed angle —see Glaucoma, angle-closure - congenital Q15.0 - corticosteroid-induced —see Glaucoma, secondary, drugs - hypersecretion H40.82-

Be careful to choose the RIGHT type of glaucoma from Alphabetical Index

Note that MOST are in the H40-H44 code range

Glaucoma Alphabetical Index

- in (due to) - - amyloidosis E85.4 [H42] - - aniridia Q13.1 [H42] - - concussion of globe —see Glaucoma, secondary,

trauma - - dislocation of lens —see Glaucoma, secondary - - disorder of lens NEC —see Glaucoma, secondary - - drugs —see Glaucoma, secondary, drugs - - endocrine disease NOS E34.9 [H42] - - eye - - - inflammation —see Glaucoma, secondary,

inflammation -- - trauma —see Glaucoma, secondary,trauma - - hypermature cataract —see Glaucoma,

secondary - - iridocyclitis —see Glaucoma, secondary,

inflammation - - lens disorder —see Glaucoma, secondary,

- - Lowe's syndrome E72.03 [H42] - - metabolic disease NOS E88.9 [H42] - - ocular disorders NEC —see Glaucoma, secondary - - onchocerciasis B73.02 - - pupillary block —see Glaucoma, secondary - - retinal vein occlusion —see Glaucoma, secondary - - Rieger's anomaly Q13.81 [H42] - - rubeosis of iris —see Glaucoma, secondary - - tumor of globe —see Glaucoma, secondary - infantile Q15.0 - low tension —see Glaucoma, open angle, primary, low- - malignant H40.83- - narrow angle —see Glaucoma, angle-closure - newborn Q15.0 - noncongestive (chronic) —see Glaucoma, open angle - nonobstructive —see Glaucoma, open angle - obstructive —see also Glaucoma, angle-closure - - due to lens changes —see Glaucoma, secondary

Note some glaucoma codes are under sections other than the H 40- H44 code range

Note the codes in Brackets [ ]

Glaucoma Alphabetical Index

- open angle H40.10- - - primary H40.11- - - - capsular (with pseudoexfoliation of lens) H40.14- - - - low-tension H40.12- - - - pigmentary H40.13- - - - residual stage H40.15- - phacolytic —see Glaucoma, secondary - pigmentary —see Glaucoma, open angle, primary,

pigmentary - postinfectious —see Glaucoma, secondary,

inflammation

- secondary (to) H40.5- - - drugs H40.6- - - inflammation H40.4- - - trauma H40.3- - simple (chronic) H40.11 - simplex H40.11 - specified type NEC H40.89 - suspect H40.00- - syphilitic A52.71 - traumatic —see also Glaucoma, secondary, trauma - - newborn (birth injury) P15.3 - tuberculous A18.59

H40.10 and H40.11 probably most common codes used in most practices

Glaucoma Tabular Listing Coding Notes H40

Cannot code with H40 code series

These codes MUST be used with other

codes

Glaucoma Tabular Listing

The DREADED 7th Character!!

These two are NOT per eye!

All MUST have 7th Character

The other four codes ARE per eye!

Complete listing not shown here!

Primary Open Angle Glaucoma Example Alphabetical Index Glaucoma: - open angle H40.10- - - primary H40.11- - - - capsular (with pseudoexfoliation of lens) H40.14- - - - low-tension H40.12- - - - pigmentary H40.13- - - residual stage H40.15-

Must go to section H40.11- in Tabular Listing

Primary Open Angle Glaucoma, both eyes mild OD, severe OS

Primary Open Angle Glaucoma Example

Primary Open Angle Glaucoma, both eyes mild OD, severe OS

Tabular Listing H40.11- This code is NOT per eye!!

Bilateral glaucoma →each eye has same type, but different stage, and classification does not distinguish laterality → one code for type of glaucoma for each eye plus seventh character for specific glaucoma stage documented

for each eye (subcategories H40.10, H40.11 and H40.20)

Final Codes-must have BOTH codes AND -”x” placeholder H40.11x1 H40.11x3

Low-Tension Glaucoma Example Alphabetical Index: Glaucoma: - low tension —see Glaucoma, open angle, primary, low-tension - - primary H40.11- - - - capsular (with pseudoexfoliation of lens) H40.14- - - - low-tension H40.12- - - - pigmentary H40.13- - - residual stage H40.15-

LOOK UNDER OPEN ANGLE,PRIMARY,LOW TENSION

Must go to section H40.12- in Tabular Listing

Low Tension Glaucoma, both eyes, moderate stage

Low-Tension Glaucoma Example

Tabular Listing 40.12- This code IS per eye!!

Low Tension Glaucoma, both eyes, moderate stage

7th required ►H40.1232 This one already has 6 places

so no “x” necessary

Glaucoma due to inflammation, left eye, mild From Chronic Iritis

Alphabetical Index: Glaucoma - in (due to) . . . - - eye - - - inflammation —see Glaucoma, secondary, inflammation . . . - secondary (to) H40.5- - - drugs H40.6- - - inflammation H40.4- - - trauma H40.3-

Under eye inflammation…

Under secondary, find inflammation

Must go to section H40.4-

Glaucoma due to inflammation, left eye, mild From Chronic Iritis

IMPORTANT NOTE!!

Glaucoma code H40.42x1

Must also find the underlying inflammation that is causing glaucoma

Glaucoma due to inflammation, left eye, mild From Chronic Iritis

Iritis —see also Iridocyclitis

Iridocyclitis H20.9 - acute H20.0- - - hypopyon H20.05- - - primary H20.01- - - recurrent H20.02- - - secondary (noninfectious) H20.04- - - - infectious H20.03- - chronic H20.1-

So, back to Alphabetic index for Iritis

Iritis sends us to Iridocyclitis

Here is the code section we need to view

Glaucoma due to inflammation, left eye, mild From Chronic Iritis

You would code also H20.12 for this case BUT which is first- glaucoma or iritis?

Glaucoma due to inflammation, left eye, mild From Chronic Iritis “Code also note” “code also” note instructs that two codes may be required to fully

describe a condition, but this note does not provide sequencing direction

BUT ICD-10-CM Guidelines state: “Wherever … there is a “use additional code” note at the etiology code,

and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. “

Further stated: “ There are manifestation codes that do not have “in diseases classified elsewhere” in the title. For such codes, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code and the rules for sequencing apply.”

Code Iritis first followed by glaucoma

H20.12 and H40.42x1

Disorders of Optic Nerve and Visual Pathways H46-H47 Excludes

This section has many Code first or code also codes

Retrobulbar Optic Neuritis Left Eye Example

Alphabetic Index Optic nerve —see condition Neuritis (rheumatoid) M79.2 . . . - optic (nerve) (hereditary) (sympathetic) H46.9 - - with demyelination G36.0 - - in myelitis G36.0 - - nutritional H46.2 - - papillitis —see Papillitis, optic - - retrobulbar H46.1- - - specified type NEC H46.8 - - toxic H46.3

Not under optic nerve

Find Retrobulbar under neuritis and then under optic nerve Must go to section H46.1-

Retrobulbar Optic Neuritis Left Eye Example

Final code is H46.12

Just when thought this example would be complex, it is not!!

Retrobulbar Optic Neuritis Left Eye Example Neuritis (rheumatoid) M79.2 . . . - optic (nerve) (hereditary) (sympathetic) H46.9 - - with demyelination G36.0 - - in myelitis G36.0 - - nutritional H46.2 - - papillitis —see Papillitis, optic - - retrobulbar H46.1-

But what if we had KNOWN it was demyelination of optic nerve??

Code would be G36.0

Optic Chiasm Field Defect-pituitary tumor Example

Alphabetical Index Vision, visual

. . . - defect, defective NEC H54.7 - disorientation (syndrome) H53.8 - disturbance H53.9 - - hysterical F44.6 - double H53.2 - examination Z01.00 - - with abnormal findings Z01.01 - field, limitation (defect) —see Defect,

visual field

Defect, defective Q89.9 - 3-beta-hydroxysteroid dehydrogenase

E25.0 . . . - visual field H53.40 - - bilateral - - - heteronymous H53.47 - - - homonymous H53.46- - - generalized contraction H53.48- - - localized - - - arcuate H53.43- - - - scotoma (central area) H53.41- - - - - blind spot area H53.42- - - - sector H53.43- - - - specified type NEC H53.45- Have to go to “Defect”

Still not the correct choice when review H53.4- section-does not describe chiasm defect

Optic Chiasm Visual Field Defect-pituitary tumor Example

Under disorder find the choice that might work

Disorder (of) —see also Disease . . . - optic - - chiasm H47.49 - - - due to - - - - inflammatory disorder H47.41 - - - - neoplasm H47.42 - - - - vascular disorder H47.43

Code would be H47.42 and underlying condition

Optic Chiasm Visual Field Defect-pituitary tumor Example

“Code also note” A “code also” note instructs that two codes may be required to fully

describe a condition, but this note does not provide sequencing direction.

Pituitary gland —see condition Tumor —see also Neoplasm, unspecified behavior, by site Neoplasm, neoplastic —see also Table of Neoplasms - pituitary(body) (fossa) (gland) (lobe)

MalignantPrimary C75.1 MalignantSecondary C79.89 Ca in situ D09.3 Benign D35.2 UncertainBehaviorD44.3 UnspecifiedBehavior D49.7

Your final code choice would depend on the type of pituitary tumor, if known

Optic Chiasm Visual Field Defect-pituitary tumor Example

If malignant pituitary tumor with optic chiasm

defect final code choice would be: C75.1 and H47.42

Optic Chiasm Visual Field Defect-pituitary tumor Example

If benign pituitary tumor with optic chiasm defect final code choice would be:

D35.2 and H47.42

Summary • Alphabetic Index FIRST unless you are quite certain of your code

choices • Watch for [ ] , code first , code also notes in alphabetical index • Look up specific code in Tabular Listing based on where Alphabetical

Index leads you. • Watch for ALL Excludes1 and Excludes2 notes • Watch for all Code First and Code Also notes • Ensure you are coding to the most specific level possible • DO NOT GUESS if you do not know because: JUST WHEN YOU THINK YOU HAVE IT, THE RULES CHANGED FOR

THAT SPECIFIC SITUATION!!

YOU HAVE BEEN WARNED

CDC ICD-10-CM Official USA site http://www.cdc.gov/nchs/icd/icd10cm.htm 2014 release of ICD-10-CM at bottom of page has all the downloads ICD-10-CM Guidelines [PDF - 512 KB] ICD-10-CM PDF Format ICD-10-CM List of codes and Descriptions (updated 7/3/2013)

CMS ICD-10-CM information

https://www.cms.gov/Medicare/Coding/ICD10/index.html

American Optometric Association www.aoa.org/coding

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

Resources

QUESTIONS?

If you have a question after today please submit via submission form on www.aoa.org/coding

Review Questions Answers will be posted on ICD-10-CM AOA Page

1. All of the glaucoma diagnoses are broken down per eye and do not require a 7th character to be added. a) True b) False

2. Which of the following glaucoma types require another diagnosis code to be coded first before the glaucoma code as listed in the alphabetic index? a) Childhood glaucoma b) Glaucoma in Lowe’s syndrome c) Malignant glaucoma d) Herpes simplex glaucoma

Review Questions Answers will be posted on ICD-10-CM AOA Page

3. How would normal tension glaucoma, mild stage right eye and open angle glaucoma, left eye, moderate stage be coded? a) H40.1211 and H40.11x2 b) H40.121 and H40.11x1 c) H40.11x4 and H40.11x2 d) H40.11x2

4. You may code any glaucoma using the glaucoma only code and never need to code any other conditions at the same time. a) True b) False

Review Questions Answers will be posted on ICD-10-CM AOA Page

5. An Exclude2 note means that you can never code the Excludes2 condition at the same time you code the original condition. a) True b) False

6. Which terms mean that another code may be required to corrected code a specific condition? a) Code first b) Code also c) Use additional code may be required d) None mean that another code could be required e) All mean that another code could be required

THANK YOU