ICD-10: Discover the Appropriate Code in 5 Steps

ICD-10: How to Find the Correct Code in 5 Steps
April 2, 2021 0 Comments

Written By: Sue Vicchrilli, COT, OCS, Academy Director of Coding and Reimbursement

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That will help you put together for the Oct. 1 implementation of ICD-10, EyeNet is offering an outline of the five-step course of for locating ICD-10 codes (see under), together with a collection of subspecialty-specific Savvy Coders, beginning subsequent month with cataract.

You’ll Want These Two Lists

Earlier than you get began, you’ll want entry to 2 units of lists.

The Alphabetical Index of diagnostic phrases (plus their corresponding ICD-10 codes) lists hundreds of “primary phrases” alphabetically. Below every of these primary phrases, there may be usually a sublist of more-detailed phrases—as an illustration, “Cataract” has a sublist of 84 phrases. Nevertheless, the Alphabetical Index doesn’t embrace coding directions, that are within the Tabular Checklist.

The Tabular Checklist of ICD-10 codes (plus their descriptors) is organized alphanumerically from A00.0 to Z99.89. It’s divided into chapters based mostly on physique half or situation. Most ophthalmology codes are in chapter 7 (Ailments of the Eye and Adnexa), however diabetic retinopathy codes are in chapter 4 (Endocrine, Dietary, and Metabolic Ailments). 

Order the lists immediately. Each might be downloaded from the CMS web site (www.cms.gov/icd10). For ophthalmologists, nevertheless, essentially the most user-friendly possibility is the ICD-10-CM for Ophthalmology: The Full Reference, which is out there in print or as a web-based subscription. One other key reference is the Ophthalmic Coding Coach, which is able to provide help to hyperlink CPT codes to ICD-10 codes.

A 5-Step Course of

Step 1: Search the Alphabetical Index for a diagnostic time period. After figuring out the time period, be aware its ICD-10 code.

Tip. The time period you’re in search of won’t be one of many primary phrases within the index, but it surely is perhaps listed beneath a kind of primary phrases. As an illustration, “Congenital cataract” is listed beneath “Cataract.” But it surely isn’t all the time that simple—“Horseshoe tear of the retina (with out detachment)” is listed beneath “Break, retina,” and “Floppy iris syndrome” is listed beneath “Floppy.”

Step 2: Verify the Tabular Checklist. Earlier than you utilize the ICD-10 code that you simply discovered within the Alphabetical Index, it is very important test that code within the Tabular Checklist to see if there are particular directions.

Instance. Should you seemed solely on the Alphabetical Index, you wouldn’t know that some glaucoma prognosis codes require a sixth character to signify laterality—1 for the suitable eye, 2 for the left eye, and three for each eyes—or a seventh character to signify staging (see “Step 5”).

Step 3: Learn the code’s directions. The code’s entry within the Tabular Checklist offers all of the prognosis code necessities.

Instance. The Tabular Checklist flags any codes that may’t be submitted for a similar eye on the identical day (see “Meet Excludes1 and Excludes2”).

Step 4: Whether it is an damage or trauma, add a seventh character. Use one of many following:

  • A to point the preliminary encounter
  • D for a subsequent encounter
  • S for sequela 

Instance. A affected person presents with a criticism of ache in the suitable eye for 2 hours. A corneal abrasion is identified. The code is S05.01 Harm of conjunctiva and corneal abrasion with out overseas physique, proper eye. That code’s entry within the Tabular Checklist instructs you so as to add a seventh character—A, D, or S. Since S05.01 is barely 5 characters lengthy, use X as a placeholder within the sixth place. Within the seventh place, add A to point an preliminary encounter—S05.01XA. When the affected person is seen in follow-up, use code S05.01XD. If the affected person develops a recurrent erosion on account of the abrasion, use code S05.01XS.

Step 5: If glaucoma, you might want so as to add a seventh character. For some diagnoses, the Tabular Checklist instructs you so as to add a seventh character for glaucoma staging codes:

  • 0 for stage unspecified
  • 1 for delicate
  • 2 for reasonable
  • 3 for extreme
  • 4 for indeterminate

Instance. The ICD-10 code H40.2232 represents bilateral continual angle-closure glaucoma, reasonable stage. Breaking that down, H40.22 represents continual angle-closure glaucoma, the three within the sixth place signifies that it’s bilateral, and the two within the seventh place represents that it’s reasonable stage.

At all times code to the very best diploma of accuracy and completeness. If there’s a fourth, fifth, sixth, or seventh digit obtainable, you have to use it.

Tip. The most effective code is the precise prognosis, the subsequent finest is an indication or symptom, and the final resort is a circumstance (V code). Solely code established situations (not possible, suspected, attainable, or rule out situations).

Know the New Terminology

As you evaluation the Alphabetical Index and Tabular Checklist, you’ll see some new phrases, a very powerful of that are described under.

“-” signifies that there are a number of prognosis code choices. Within the Alphabetical Index, you’ll see listings during which a splash (-) seems on the finish of the code: As an illustration, Fragments, cataract (lens), following cataract surgical procedure H59.02-. The sprint signifies that the Tabular Checklist consists of extra particular code choices, on this case for laterality—H59.021 for the suitable eye, H59.022 for the left, and H59.023 for each. Since you are obliged to make use of essentially the most particular code obtainable, it might be inadequate to submit H59.02 with out indicating the laterality.

Within the Tabular Checklist, you will notice the sprint used for cross-referencing.

“And” means and/or. When “and” seems in a title—as in H26.0 Childish and juvenile cataract—it means and/or.

“X” is used as a placeholder. You typically want so as to add a seventh character—as an illustration, to point glaucoma staging—to a code that solely has 5 characters. In that case, use X as a placeholder within the sixth place.

Instance. If the prognosis is main open-angle glaucoma, extreme stage, in the suitable eye, submit H40.11X3. Whereas some glaucoma codes require you to point laterality (utilizing the sixth character), that’s not the case with H40.11. However you might be required to point staging, which is completed with the seventh character, so you must use X as a placeholder.

Meet Excludes1 and Excludes2

Once you search for a code within the Tabular Checklist, you might even see a number of different codes listed in an Excludes be aware. There are two varieties—Excludes1 and Excludes2—and the 2 serve very completely different functions.

An Excludes1 be aware flags codes which you can’t submit collectively. Such a Excludes be aware serves the identical function as ICD-9’s Excludes notes: It flags situations that may’t be reported collectively, together with mutually unique prognosis codes (as an illustration, a congenital situation can’t even be an acquired situation).

Instance. In chapter 7 of the Tabular Checklist, H02.81 Retained overseas physique in eyelid has an Excludes1 be aware that lists Laceration of eyelid with overseas physique (S01.12-), Retained intraocular overseas physique (H44.6-, H44.7-), and Superficial overseas physique of eyelid and periocular space (S00.25-). Which means when you invoice one of many H02.81- codes, you possibly can’t invoice any of these different codes on the identical day for a similar eyelid.

In one other instance, H35.35 Cystoid macular degeneration has an Excludes1 be aware that lists Cystoid macular edema following cataract surgical procedure (H59.03-).

An Excludes2 be aware flags codes that you simply might be able to invoice for a similar eye on the identical day. When a code’s itemizing consists of an Excludes2 be aware, the code(s) listed in that be aware are ones {that a}) are usually not a part of the situation that’s represented by the primary code and b) can—when acceptable—be reported along with the primary code. 

Instance. H11.1 Conjunctival degenerations and deposits has an Excludes2 be aware that lists H11.81 Pseudopterygium. Which means ICD-10 doesn’t embrace pseudopterygium as a part of any situation represented by the H11.1- codes, however it’s attainable for a affected person to have each on the similar time—and if that’s the case along with your affected person, you’d submit the related H11.1- code together with H11.81.

The Academy Is the Acknowledged Authority in Ophthalmic Coding

That will help you appropriately maximize reimbursement, Academy specialists have developed a beneficial library of coding merchandise. These embrace ICD-10-CM for Opthhalmology: The Full Reference.

Codequest is coming to a metropolis close to you. Keep updated on shifting laws, compliance, and techniques for maximizing reimbursement. You may’t afford to overlook a very powerful coding occasion of the yr. Register now at aao.org/codequest.

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