ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com Jeffrey Restuccio, CPC, CPC-H, M BA M emphis TN (901) 517-1705 jeff@eyecodingforum.com www.EyeCodingForum.com EyeCodingForum.com 1
Coding for Contact Lens Complications • M any common conditions/ diseases are not listed in the current ICD-9 manual. How will they translate to ICD-10? Will it correct all the omissions and incorrect descriptions currently found in ICD-9? • For the most part, no. • Y es, Dry Eye Syndrome will now be part of the ICD-10 code description. H04.121 Dry eye syndrome of right lacrimal gland • But many will continue to retain international descriptions that are different from common terms used in the United States. EyeCodingForum.com 2
T op Five Contact Code Problem ICD-9 Codes/ Conditions • ICD-9 and Description ICD-9 Description 368.8 Blurred Vision 379.91 Eye Pain 379.93 Redness of Eyes 375.15 Dry Eyes 368.2 Double Vision/ diplopia This list includes about 80% of visits for contact lens-related problems. EyeCodingForum.com 3
ICD-10 Crosswalk • Note separate diplopia and double vision codes. Other specified disorders of eye and adnexa [blurred 1) H57.8 vision crosswalk] 2) H57.13 Ocular pain, bilateral [four codes] 3) H57.8 Other specified disorders of eye and adnexa [redness] 4) H04.121 Dry eye syndrome of right lacrimal gland [four codes] 5) H53.2 Diplopia [ICD-9 crosswalk to 368.2] Other subjective visual disturbances [Includes: H53.19 Double vision; ICD-9 crosswalk: 368.15] 368.15: Subjective visual disturbances: other visual distortions and entoptic (visual effects whose source is within the eye itself) phenomena EyeCodingForum.com 4
Common Coding Errors 371.82 Corneal Disorder due to Contact Lens Corneal Edema due to Wearing of Contact Lens [this is 375.15 an error per ICD-9] • The two codes are recommended above but 375.15 is clearly incorrect per ICD-9 guidelines. Corneal pigmentations and deposits: other deposits associated with metabolic disorders [actual ICD-9 371.15 description] Other corneal disorders: corneal disorder due to 371.82 contact lens Excludes corneal edema due to contact lens (371.24) EyeCodingForum.com 5
Correct Contact ICD-10 Codes • Correct ICD-9 code Corneal edema: corneal edema due to wearing of 371.24 contact lenses Corneal edema secondary to contact lens, H18.219 unspecified eye 371.82 Corneal Disorder due to Contact Lens H18.829 Corneal disorder due to contact lens, unspecified eye EyeCodingForum.com 6
Other conditions • How does one code for: more serious conditions like corneal hypoxia, infiltrates, and microbial keratitis? EyeCodingForum.com 7
Terms and definitions • SEAL: Superior Epithelial Arcuate Lesion: It is a white lesion in the superior cornea that can be up to 0.5 mm wide and from 1 mm to 5 mm long. • CLARE: Contact Lens-induced Acute Red Eye: A sudden onset of a corneal infiltrative event observed during extended wear of hydrogel contact lenses that is always associated with sleep. Patients report waking up with irritation or pain, redness and watery eyes. Sometimes, these symptoms are not noticed until soon after waking (HPI: timing). • CLPU: Contact Lens-induced Peripheral Ulcer: A circular, well- circumscribed, dense, yellowish-white, focal corneal infiltrate (0.2 mm to 2.0 mm in diameter) located in the peripheral to mid- peripheral cornea. It is always located in the anterior stroma and has a complete loss of overlying epithelium. S ymptoms can vary but may include pain or soreness, irritation and watering. EyeCodingForum.com 8
Terms and definitions • M icrocysts: Small (15 μm to 50 μm ), irregularly shaped inclusions, typically found in the paracentral to mid-peripheral zones of the cornea, best observed with retro-illumination. These show reversed illumination due to a suspected higher refractive index than the surrounding tissue. • Often clear and asymptomatic. Report the underlying symptoms: EyeCodingForum.com 9
Terms and definitions • M K — M icrobial Keratitis : occurs as a result of an infection of the cornea by replicating microbes (bacterial, viral, fungal or amoebae). In contact lens wear, it is usually preceded by hypoxia and/ or an epithelial break. Contact lens wearers, in particularly extended wear, are more prone to develop M K. The most common bacteria associated with contact lens- related M K is Pseudomonas aeruginosa. • Bacteria tend to bind to the back surface of silicone hydrogel lenses after patients have been swimming. Always recommend that patients remove and disinfect their lenses after any exposure to pools, lakes or rivers. EyeCodingForum.com 10
Top M K Symptoms ICD-9 Codes • Top codes 1 370.03 Corneal Ulcer, Central 2 364.03 Secondary Iridocyclitis, Infectious Unspecified disorder of eye and adnexa: pain in or 3 379.91 around eye [eye pain] Other specified disorders of eye and adnexa [ 4 379.93 redness of Eyes] 4 375.21 Epiphora 5 368.13 Photophobia EyeCodingForum.com 11
Top M K Symptoms ICD-9 Codes • ICD-10 crosswalk. Not always exact. 1 H16.011 Corneal Ulcer, Central 2 Secondary Iridocyclitis, Infectious Secondary infectious iridocyclitis, right eye [also H20.031 noninfectious, H20.041] 3 H57.13 Ocular pain, bilateral 4 H57.8 Redness of Eyes [no eye code] 5 H04.201 Unspecified epiphora, right lacrimal gland Epiphora due to excess lacrimation, right H04.211 lacrimal gland Epiphora due to insufficient drainage, right H04.221 lacrimal gland EyeCodingForum.com 12
Top M K Symptoms ICD-9 Codes • ICD-10 crosswalk. Not always exact. 6 H53.149 Photophobia Visual discomfort, right eye [Includes: M etamorphopsia; photophobia term not in H53.149 ICD-10] • Only report those codes documented, relevant to this encounter, and sufficient to support medical necessity for a given procedure or office visit. EyeCodingForum.com 13
Other Complications • Exposure keratitis is not found in the ICD-9 manual. It is listed as: exposure keratoconjunctivitis • It is an incomplete closure of the eyelid causing a dry, inflamed eye. Certain types of keratoconjunctivitis: exposure 370.34 keratoconjunctivitis H16.219 Exposure keratoconjunctivitis, unspecified eye EyeCodingForum.com 14
Exposure keratoconjunctivitis • All codes; Note codes are not by eyelid. H16.211 Exposure keratoconjunctivitis, right eye H16.212 Exposure keratoconjunctivitis, left eye H16.213 Exposure keratoconjunctivitis, bilateral H16.219 Exposure keratoconjunctivitis, unspecified eye EyeCodingForum.com 15
Keratoconjunctivis sicca • Keratoconjunctivitis sicca has two options in ICD-9. • The condition involves reporting biomicroscopic findings without referring to the underlying cause. 710.2 Diffuse diseases of connective tissue: sicca syndrome Keratoconjunctivitis sicca Sjogren's disease [Sjögren's syndrome] Certain types of keratoconjunctivitis: keratoconjunctivitis sicca, not specified as Sjogren's [dry 370.33 eyes] EyeCodingForum.com 16
Remember, International Definitions • Keratoconjunctivitis sicca (KCS), (aka keratitis sicca, xerophthalmia or dry eye syndrome , is an eye disease caused by eye dryness it is caused by either decreased tear production or increased tear-film evaporation. Keratoconjunctivitis sicca, not specified as Sjögren's, H16.221 right eye Keratoconjunctivitis sicca, not specified as Sjögren's, H16.222 left eye Keratoconjunctivitis sicca, not specified as Sjögren's, H16.223 bilateral Keratoconjunctivitis sicca, not specified as Sjögren's, H16.229 unspecified eye EyeCodingForum.com 17
Dry Eye Syndrome • Use the following ICD-10 code for DES H04.121 Dry eye syndrome of right lacrimal gland H04.122 Dry eye syndrome of left lacrimal gland H04.123 Dry eye syndrome of bilateral lacrimal glands H04.129 Dry eye syndrome of unspecified lacrimal gland EyeCodingForum.com 18
Sicca Syndrome ICD-10 • GEM S Crosswalk of ICD-9: 710.2 • Listed also as Sjögren's syndrome : a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands, which produce tears and saliva. Unless it was diagnosed separately, M 35.01 would be the correct code. ICD-10 Description M 35.00 Sicca syndrome, unspecified M 35.01 Sicca syndrome with keratoconjunctivitis EyeCodingForum.com 19
M ore Terms • CLPC : Contact Lens-induced Papillary Conjunctivitis (Aka Giant Papillary Conjunctivitis [ GPC]): S ymptoms may range from mild hyperemia of the upper tarsal conjunctiva with a few, small papillae to severe hyperemia with large, raised papillae, which have a cobblestone appearance. CLPC may present as a localized or generalized response. S ymptoms include itching and a stringy or ropy mucous discharge. Excessive lens movement or decentration and blurred vision may also occur. Lens material, design or fitting characteristics may need to be modified to prevent recurrence of this condition. Etiologies for CLPC include: mechanical abrasion from poor edge design and protein film abrasiveness. • A code does exist, but it's not called GPC. It all depends on the etiology. Since papillae aren't follicles, we can't use the code for follicular conjunctivitis. EyeCodingForum.com 20
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