2018 ICD-10 Updates for Ophthalmology and Optometry

Join us noon CST, July 27 2017 for our early look at the new 2018 ICD-10 code additions, changes, and deletions for optometry and ophthalmology. This Webinar is about 50-minutes. In addition to being recorded (watch anytime) we plan on conducting this same Webinar live in August, September and October. Every Eyecare Office must conduct new code training every year. It includes:

  1. New ICD-10 codes for 2018 for Eyecare
  2. Changes to degenerative myopia
  3. Changes to blindness codes
  4. Changes to low vision codes
  5. Other code changes
  6. Deleted codes
  7. Revised codes
  8. Formal ICD-10 coding training
  9. When two codes are required and not just one.
  10. Disease specificity
  11. Exceptions and “Gotchas”

This Webinar is $49 or buy a block of 4 for $149; or purchase the Site License (over 40 Webinars plus the next 12 Webinars for a full year) for only $499. Click on This link to Order EyeCodingForum Services.

Click here for a list of all available EyeCare Coding and Billing Webinars.

Twelve EyeCare ICD-10 Questions to Assess Your Knowledge

In 2017 every Eyecare clinic needs to up their game in terms of ICD10 coding specificity. Remember, you don’t need to outrun the lion, just the 90% of Eyecare clinics who do not take this seriously. That’s how you become a top ten-percent earner in Eyecare [Optimize  Compliance/Maximize Revenue]

If you work in an optometry or ophthalmology office the following questions below will help you assess your ICD-10 coding and documentation knowledge. These are not basic ICD-10 questions but more representative of how accurate coding can help your practice optimize r compliance and maximize revenue. The answers to the questions below are all in the EyeCodingForum ICD-10 recorded video training course.

Please share these with everyone you know in Eyecare:

  1. How do you report a dense cataract?
  2. How do you report a rule-out of a blowout fracture?
  3. How do you report a nasal or temporal pterygium?
  4. Does blurred vision [H53.8] support medical necessity?
  5. In ICD-10 you cannot report wet or dry ARMD by eye (right or left) [True or false?].
  6. How do you report “uncontrolled diabetes Type II” in ICD-10?
  7. Is degenerative myopia [H44.2*] paid on a medical claim?
  8. Which code categories do not have a bilateral (3) option?
  9. How do you know how to sequence ICD-10 codes on the claim form? [What is a good source of this information?]
  10. How do you report bacterial conjunctivitis?
  11. Is refractive amblyopia [H53.02*] paid on a medical claim?
  12. Can the removal a suture, stent, conjunctival concretion removal be coded as a foreign body removal?

Jeffrey Restuccio, CPC, COC
(901) 517-1705

Updated 2017 ICD-10 Cheat Sheet for Eyecare Available Now

This is an updated, 4 1/3 page PDF document. It will be emailed to you as a PDF file. The update is only $25 for those who purchased previously the 4-page ICD-10 coding cheat sheet. It is the fifth option on the purchase form (Under the Order tab)

With all the new codes it just did not fit on 4 pages so I’m offering it as a PDF file and you can print copies for your office (only).

If you are interested you can order the Sept 15 ICD-10 update webinar and the cheat sheet update is included at no extra cost.

Jeffrey Restuccio, CPC, COC


September 15: New ICD-10 changes for Eyecare

This 50-minute webinar was recorded on Sep 15 and is now available immediately. It is only $49. The fee is per clinic. You can watch it anytime and as many times as you want. This Webinar will be specific to ophthalmology and optometry (Eyecare).

It has been four years since the last regular annual update to the ICD-9-CM and ICD-10 code sets. On October 1, 2016 ICD-10 will include over 1,900 new codes including four significant changes to Eyecare codes as well as 800 newly released 2017 ICD-10 injury codes. We will cover not only codes directly related to Eyecare as well as those peripherally related. Making even a small mistake can lead to significant denials and revenue losses for your practice.

  1. New ICD-10 codes for 2017
  2. Formal ICD-10 coding training
  3. When two codes are required and not just one.
  4. Changes to open-angle glaucoma codes.
  5. Changes to diabetic retinopathy codes
  6. Changes to macular degeneration codes.
  7. Changes to central and branch retinal vein occlusions
  8. Disease specificity
  9. Exceptions and “Gotchas”
  10. Coding accidents and injuries

Be prepared. Don’t let the insurance companies deny your claims and reduce your income. If your coders and providers have not had comprehensive ICD-10 coding training (at least six hours) you will not be able to fix this in just one or two hours after Oct. 1. It takes training, periodic audits, reviews and continued training and monitoring.

This Webinar is included in our Site License or order a bundle of four for a 50 % discount. If you have any questions please be sure to send them to us beforehand: jeff@eyecodingforum.com

Click here to Order.

Priority Question and Answer Service for coding, billing, and documentation questions

This support service will use a formal Ticket System plus include a  searchable Knowledge-Base (KB), organized by category with hundreds of the most common Eyecare coding and billing questions. The goal is to answer all posted questions within 24 hours. The KB will be available 24X7. Most questions should be answered the same day, during normal business hours (M-F, 8-5).

Until the end of October, you can test out the system below. You can view over 75 of the most common questions in the knowledge-base without creating a user ID.


After Nov 1 if you wish to test the system send us an email on our contact form and we will set you up with a temporary ID. You have a coding question, post it and then you will be notified of a response within 24-48 hours.

This Priority Q and A service is available for only $25 per month or free toall EyeCodingForum:

  1. Site License clients ($499 per year)
  2. ICD-10 Comprehensive Coding Course clients ($275 until Oct 1 2016).

Remember just one paid claim or coding question solved could pay for the service for an entire year.


Jeffrey Restuccio, CPC, COC, MBA
Coding Specialist in Eyecare

ICD-10 Coding Exercises for Eyecare – 125 Questions

The EyeCodingforu has been posting ICD-10 coding exercises for Eyecare on our website the last two months. The attached document is the latest version with 125 coding exercises. Most, but not all of the answers, are on the 4-page cheat sheet. This document replaces all other ICD-10 coding exercise lists.

ICD-10 Coding for Eyecare Oct 1 2015 125 Questions

Use whatever method you’ve chosen to select codes:

  1. Cheat sheet
  2. Lookup program (Practice Management, ERM, or third-party)
  3. Coding from the manual.

Of course coding from the manual is the only way to ensure accurate, specific, and compliant coding. These questions will help you identify GAPS in your current knowledge and coding system and whether you may need additional training. After entering your codes on Thursday and Friday you might want to scan this list for codes used less frequently. The top 20% are easy. It’s best to become familiar with the less common codes before you have a busy day and then a half-dozen conditions you’ve never coded before. In addition there are bunch of exceptions and “gotcha’s” as I called them in ICD-10. Most took many months of study to find.

The answer key is available to all ICD-10 and Site License subscribers. The ICD-10 training will be updated several times with carrier-specific feedback and is good for one year from purchase.

Articles posted on the EyeCodingForum.com include definitions of mild, moderate and severe glaucoma stages, low and high risk glaucoma, the updated definition of “active treatment” for the “A” extender code, and much more.

Workers Compensation and ICD-10

While healthcare providers and physicians may be scrambling to get ready for ICD-10, workers’ compensation practitioners are not required to switch to the new codes, according to the Workgroup for Electronic Data Interchange (WEDI), an advisor to the Department of Health and Human Services.

Approximately one-half of the Workers compensation claims systems are ready to switch to ICD-10 on October 1. About one-half, or 26 states will continue to use ICD-9 codes after Oct. 1 2015. Therefore your PM system will have to support switching between ICD-9 and ICD-10. Plus you staff has to be well-trained to avoid any confusion.

[Also: ICD-10 checklist: AHA releases step-by-step preparation guide]

WEDI has released data on worker’s compensation readiness by state. Twenty-one states have adopted ICD-10 billing for physicians, hospital inpatients and outpatients, according to WEDI.

ICD-10 ready: Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington.

Three states have adopted ICD-10 codes for hospital inpatient billing only: Indiana, Maine and South Carolina.

[Also: With ICD-10 about a month away, healthcare providers say ‘bring it on’]

Continue with ICD-9: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Hawaii, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming.

If you hear anything different please email me at ecf@eyecodingforum.com and we will update this post.

Glaucoma Stage Code Definitions: mild, moderate and severe

The stage coding is based on the Eyecare professional’s judgment. There are several different definitions of the stages, which will be summarized below.

Mild Damage — American Optometric Association Definition

  • Optic Nerve – mild concentric narrowing or partial localized narrowing of the neuroretinal rim; disc hemorrhage; cup/disc asymmetry
  • Nerve Fiber Layer – less bright reflex; fine striations to texture; large retinal blood vessels clear; medium retinal blood vessels less blurred; small retinal blood vessels blurred
  • Visual Field – isolated paracentral scotomas; partial arcuate or nasal step; damage limited to one hemifield with fewer than 25% of points involved, mean deviation (MD) less than -6 dB

Mild Damage — American Academy of Ophthalmology Definition

  • Optic nerve changes consistent with glaucoma but NO visual field abnormalities on any visual field test OR abnormalities present only on short-wave-length automated perimetry or frequency doubling perimetry

Mild Damage — CMS Definition

  • One or more of the following in the worst eye
  • Intraocular pressure >22mmHG
  • Symmetric or vertically elongated cup enlargement, neural rim intact, cup/disc ration > 0.4
  • Focal optic disc notch
  • Optic disc hemorrhage or history of optic disc hemorrhage
  • Nasal step or small paracentral or arcuate scotoma
  • Mild constriction of visual field isopters

Moderate Damage — American Optometric Association Definition

  • Optic Nerve – moderate concentric narrowing of the neuroretinal rim; increase in the area of central disc pallor; a complete localized notch or loss of the neuroretinal rim in one quadrant; undermining of vessels
  • Nerve fiber layer – minimal brightness to reflex; no texture; large, medium, and small retinal blood vessels clear
  • Visual field – partial or full arcuate scotoma in at least on hemifield; damage may involve both hemifields; fixation should not be involved; mean deviation between -6 dB and -12 dB

Moderate Damage — American Academy of Ophthalmology Definition

  • Optic nerve changes consistent with glaucoma AND glaucomatous visual field abnormalities in one hemifield and not within 5 degrees of fixation.

Moderate Damage — CMS Definition

  • One or more of the following in the worst eye
  • Enlarged optic cup with neural rim remaining but sloped or pale, cup/disc ration >0.5 but <0.9
  • Definite focal notch with thinning of the neural rim
  • Definite glaucoma visual field defect (arcuate/paracentral scotoma), nasal step, pencil wedge, constriction of isopters

Severe Damage — American Optometric Association Definition

  • Optic Nerve  – complete absence of the neroretinal rim in at least three quadrants; bayoneting of vessels; markedly increased area of central disc pallor
  • Nerve fiber layer – reflex dark; no texture; large, medium, and small retinal blood vessels clear
  • Visual field – advanced loss in both hemifields; 5-10 degrees central island of vision; mean deviation worse than -12 dB

Severe Damage — American Academy of Ophthalmolgy Definition

  • Optic nerve changes consistent with glaucoma AND glaucomatous visual field abnormalities in both hemifields and/or loss within 5 degrees of fixation in at least on hemifield.

Severe Damage — CMS Definition

  • One of more of the following in the worst eye
  • Severe generalized constriction of isopters
  • Absolute visual defects within 10 degree of fixation
  • Severe generalized reduction of retinal sensitivity
  • Loss of central visual acuity, with temporal island remaining
  • Diffuse enlargement of optic nerve cup, with cup to disc ratio >0.8
  • Wipeout of all or a portion of the neural retinal rim

If both of the patient’s eyes are glaucomatous, always report for the more severe stage of the two eyes. If the two eyes have different types of glaucoma, document each eye with its type and assign a stage code for each eye.

The indeterminate code would be used when you see a patient that you haven’t yet had time to do a visual field on, the patient just can’t perform a visual field test, or it’s so unreliable or uninterruptable that you really are unsure what level or state they are at.

Risk factors for glaucoma with borderline findings

H40.01*: Open angle with borderline finding, low risk (1-2 risk factors) [Code has laterality] (365.01)

H40.02*: Open angle with borderline findings, high risk (3 or more risk factors) [Code has laterality] (365.05)

The list below includes glaucoma risk factors according the Mayo Clinic:

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these factors:

Elevated internal eye pressure (intraocular pressure). If your internal eye pressure (intraocular pressure) is higher than normal, you’re at increased risk of developing glaucoma, though not everyone with elevated intraocular pressure develops the disease.

Age. You’re at a higher risk of glaucoma if you’re older than age 60, particularly if you’re Mexican-American. You may be at higher risk of angle-closure glaucoma if you’re older than age 40. For certain groups such as African-Americans, however, the risk of developing glaucoma is much higher and occurs at a younger age than that of other groups. If you’re African-American, ask your doctor when you should start having regular comprehensive eye exams.

Ethnic background. African-Americans older than age 40 have much higher risk of developing glaucoma than do whites (Caucasians). African-Americans also are more likely to experience permanent blindness as a result of glaucoma. People of Asian descent have an increased risk of developing acute angle-closure glaucoma. People of Japanese descent may be more likely to have normal-tension glaucoma.

Family history of glaucoma. If you have a family history of glaucoma, you have a greater risk of developing it. Glaucoma may have a genetic link, meaning there’s a defect in one or more genes that may cause certain individuals to be more susceptible to the disease. A form of juvenile open-angle glaucoma has been clearly linked to genetic abnormalities.

Medical conditions. Several conditions may increase your risk of developing glaucoma, including diabetes, heart diseases, high blood pressure and hypothyroidism.

Other eye conditions. Severe eye injuries can cause increased eye pressure. Other eye conditions that could cause increased risk of glaucoma include eye tumors, retinal detachment, eye inflammation and lens dislocation. Certain types of eye surgery also may trigger glaucoma. Also, being nearsighted or farsighted may increase your risk of developing glaucoma.

Long-term corticosteroid use. Using corticosteroid medications, especially eyedrops for a long period of time may increase your risk of developing secondary glaucoma.


August 28 ICD-10 Coding Questions for ophthalmology and optometry

Prepare for Oct 1 by working the 12 attached coding questions.

aug 28 questions

The answers are made available to our ECF ICD-10 clients (4-page form or comprehensive course).

We will package all ICD-10 questions for Eyecare shortly with the answer key.