Article

Proposed ICD-10 Retinal Code Changes for 2017 Released

A brief guide to the coming modifications

Proposed ICD-10 Retinal Code Changes for 2017 Released

A brief guide to the coming modifications

PAUL M. LARSON, MBA, MMSc, COMT, COE, CPC, CPMA

Set your “wayback machine” to October 1, 2015, the day we all began submitting ICD-10 codes to payers … and waited for payment. The sky did not fall — and while it wasn’t a completely smooth transition, it did go rather well for something so all-encompassing.

Importantly, there were some provisions of the rules with the ICD-10 rollout1,2 that were not considered in October. Remember that a code freeze for both ICD-9 and ICD-10 was put into place when ICD-10’s original rollout date was promulgated.

That freeze lasted through September 30, 2015. Specialty committees that had identified coding issues that they were unable to change could begin working again. Importantly, while the code freeze did help with training, these very same regulations noted that regular updates to ICD-10 would resume with the 2017 code set.

The proposed ICD-10 2017 code changes that take effect on October 1, 2016, have already been released; in all of eye care, few subspecialties are as impacted as retina. Many of the changes are welcome because ICD-10 had a few codes that were just illogical:

    • Open-angle glaucoma codes had no right eye/left eye designation but did have a “staging” designation that we all had to learn.

    • Diabetic retinopathy coding had options for the presence/absence of macular edema and stage of retinopathy but no laterality,

    • The most common macular degeneration codes for “wet” or “dry” had no laterality despite significant payer interest in intravitreal drug therapy.

Here, I review the most recent changes.

Paul M. Larson, MBA, MMSc, COMT, COE, CPC, CPMA, is a senior consultant with the Corcoran Consulting Group in San Bernardino, CA. He can be reached via e-mail at plarson@corcoranccg.com.

CHANGES AHEAD

Let’s review what isn’t different first. Right eye, left eye, and bilateral remain for the most part “1,” “2” and “3,” respectively. When there are injuries requiring coding a seventh character “A,” “D,” or “S,” the definitions remain the same. Codes that already had laterality in the 2016 code set we have been using will remain the same for the most part. When a code gets an update, the old code is most often deleted.

What is different, then? If we move the “wayback” machine dial forward to the new rollout date of October 1, 2017, some of the 2016 codes we are actually becoming accustomed to using (H35.31, for nonexudative age-related macular degeneration) can’t be used any more.

This is not the only deleted or changed code; the American Academy of Professional Coders undertook a comprehensive review, and they noted that there are “1,900 new ICD-10-CM codes proposed … and 313 deletions and 351 revised codes.”3

While there are significant retinal code changes, you and your staff don’t need to know all 1,900 changes! There are some basic rules that you already know (see the laterality designations above) that can help you make sense of them. You can also look at the 2017 proposed list on the Centers for Disease Control and Prevention Web site.4

Here are the basic changes that roll out on October 1, 2016, that affect retinal physicians. Most of them are shown in the Table, but the major changes to note are as follows.

Table. ICD-10 for Eye Care: 2016 vs 2017
2016 PROPOSED FOR 2017 (EFFECTIVE ON 10/01/2016)
H35.31 (Dry AMD) H35.3111 (Nonexudative AMD, OD, early dry stage)
H35.3112 (Nonexudative AMD, OD, intermediate stage)
H35.3133 (Nonexudative AMD, OU, advanced atrophic without subfoveal involvement)
H35.3134 (Nonexudative AMD, OU, advanced atrophic with subfoveal involvement)
Eye is 6th character
AMD stage and subfoveal involvement is 7th character
H35.32 (Wet AMD) H35.3211 (Exudative AMD, OD, w/active CNV)
H35.3222 (Exudative AMD, OS, w/inactive CNV)
H35.3233 (Exudative AMD, OU, w/inactive scar)
Eye is 6th character (wet or dry)
AMD stage, activity, and scar is 7th character
E11.329 (Type II DM, mild NPDR, no DME) E11.3293 (Type II DM, mild NPDR, no DME, bilateral)
E11.3532 (Type II DM, PDR, traction RD not involving macula, OS)
H33.41 (Traction RD of retina OD) E10.3521 (Type I DM, PDR, traction RD involving macula, OD)
E10.3531 (Type I DM, PDR, traction RD not involving macula, OD)
H33.01 (Rhegmatogenous RD w/single break OD) E10.3541 (Type I DM, PDR, combined traction RD & rhegmatogenous RD, OD)
Eye is 7th character (codes were a maximum of 6 characters long)
H40.11x2 (OAG, moderate stage) H40.1122 (OAG, OS, moderate stage)
H40.1132 (moderate stage OU, OAG)
Eye is 6th character
Staging is still 7th character - as before
H34.811 (CRVO, OD) H34.8110 CRVO, OD, w/macular edema
H34.8111 CRVO, OD, w/retinal neovascularization
H34.8112 CRVO, OD, stable
Eye is 6th character
7th character: “0,” “1,” “2” for +/- ME or stable
H34.833 (BRVO, OU) H34.8330 BRVO, OU, w/macular edema
H34.8331 BRVO, OU, w/retinal neovascularization
H34.8332 BRVO, OU, stable
Eye is 6th character
7th character: “0,” “1,” “2” for +/- ME or stable

Our most common macular degeneration code — H35.31 — gets both laterality and staging. It also gets “with” and “without” subfoveal involvement:

    • Exudative AMD will have options for laterality, stage (early, intermediate, and advanced atrophic), and active/inactive choroidal neovascularization options.

    • All of the diabetic retinopathy codes (those that begin with E08, E09, E10, E11, and E13) have laterality.

    • Proliferative diabetic retinopathy codes now have “stable,” “tractional,” “rhegmatogenous,” and “involving or not involving the macula” retinal detachment options, in addition to laterality.

    • Coding for central and branch retinal vein occlusions is slightly changed to include new options for “with macular edema,” “with retinal neovascularization,” and “stable.” Remember that branch retinal veins are known as “tributary” in ICD-10. Laterality that was already there remains.

CONCLUSION

The code freeze is no longer in effect; there will be some changes/additions/deletions to ICD-10 moving forward. A great number of the ophthalmology coding ICD-10 updates for 2017 affect retinal physicians.

Vigilance is key because new codes will be added and others deleted. As emphasized at your practice’s ICD-10 training, monitor your documentation and claims to ensure proper code use and reimbursement. RP

REFERENCES

1. Federal Register. Vol 79, No 149. August 4, 2014. Available at: https://www.gpo.gov/fdsys/pkg/FR-2014-08-04/pdf/2014-18347.pdf. Accessed May 31, 2016.

2. Centers for Medicare & Medicaid Services (CMS). Partial Code Freeze for ICD-9 and ICD-10. Available at: https://www.cms.gov/medicare/coding/icd10/downloads/partial_code_freeze.pdf. Accessed May 31, 2016.

3. Dustman R. Prepare for thousands of ICD-10 code changes. American Association of Professional Coders. Available at: https://www.aapc.com/blog/34105-prepare-for-thousands-of-icd-10-code-changes/. Accessed May 31, 2016.

4. Centers for Disease Control and Prevention. (See FY2017 New Released ICD-10-CM codes link). Available at: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm. Accessed May 31, 2016.