Quick LCD list with ICD-10 Codes

WPS Medicare now offers their LCD’s with either ICD-9 or ICD-10 codes. You can compare and contrast both lists. Click here for a complete list.

 

 

 

 

Aug 21ICD-10 Coding Exercises for Eyecare

See the link below to download the PDF file of 12 questions for August 21 2015.

AUG 21 update coding exercises

Answers are provided to ICD-10 course, 4-page ICD-10 list, and all Site License EyeCodingForum clients.

Thanks for your support!

Aug 14 ICD-10 Coding Exercises for Eyecare

See the link below to download the PDF file.

Aug 14 Weekly ICD-10 coding examples for Eyecare – Questions Only 2015

Answers are provided to ICD-10 course, 4-page ICD-10 list, and all Site License EyeCodingForum clients.

Thanks!

August 7 ICD-10 Coding Exercises for Eyecare

August 7 2015 list of 12 ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet. Click on the link below to download the PDF.

Aug 7 Weekly ICD-10 coding examples for Eyecare Questions

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

Click Here to Order EyeCodingForum Services.

Jeffrey Restuccio, CPC, CPC.
jeff@eyecodingforum.com
(901) 517-1705

ICD-10 Updates and Clarifications July 2015

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities

JPR: The information below is from the Medicare document above.

As stated in the CMS’ Guidance, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes. However, they are subject to specific LCD or NCD requirements.

JPR: I can think of few unspecified eye codes: ARMD, ectropion, scleritis, or amblyopia that would cause a denial. Most LCD’s for Eyecare include ranges of codes and do not exclude the “unspecified code.” As a certified coder, I am taught that the most specific codes and the group of codes that most accurately reflect the encounter, based on coding guidelines is the proper way to report the service.

For one, unspecific codes inform the world that the provider “does not know what is wrong with the patient.” Both the clinic manager and the provider should want to avoid this impression. While most won’t be able to be in the top ten-percent of clinics in terms of coding accuracy–you don’t want to be in the bottom 50% and certainly not the bottom 10-percent. Being specific, accurate, and following all coding guidelines is the best strategy to get paid, every time, and in all situations, by all carriers. Lastly, if the providers ever wanted to practice medicine because they wanted to help people, here is their opportunity. We need the specificity and additional status codes for research. Universities  worldwide are waiting on more specific data to help prevent and cure diseases. As I stated earlier, improve your diagnosis reporting because it’s the right thing to do.

In another example, a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD-10 implementation, since they are all in the same family of codes.

JPR: Most in Eyecare use the unspecific headache codes. I recommend, in my ICD-10 training that the provider report the headache more specifically as tension, migraine, ocular, retinal, etc…There is no way for the carrier to know which type of migraine the patient has and the auditor would actually have to review the notes and compare them to the specific code reported. Not all auditors do this so this would be a rare phenomenon.

Question 4: What should I do if my claim is rejected? Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a NCD or LCD or other claim edit?

Answer 4: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.

Question 5: What is meant by a family of codes? (Revised 7/31/15)

Answer 5: “Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters.

One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

The three official CMS documents are available to download below:

Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement

AMA-CMS-press-release-letterhead-07-05-15

MedicareProviderICD-10_July_7_2015

Update to explanation for initial versus a subsequent encounter

This is an update and correction concerning the explanation for initial versus the subsequent office visit encounter (follow-up) for any injury.

In both the live and recorded course I used the new patient and existing patient guidelines to determine whether the visit was initial (XA) or subsequent (XD). While there are some grey areas in the official explanation I am revising my opinion on this matter based on additional information and feedback. The bold and italics below are mine.

This is per the AHA ICD-10 Coding Guidelines Manual Nov 2014 (Chapter 19: pgs 66-67) (full document link at the end of this article):

7th character “A”, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

It could be argued whether the list above means “and” or “or.” Is the new physician a requirement or does the active treatment by any new physician determine it’s initial?

7th character “D” subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition.

The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter).

Additional Notes are from the article below:

Per Guest Contributor, Debra Mitchell, MSPH, CPC-H, In Coding Edge April 1, 2014,  “Take the patient’s perspective when appending the seventh character in ICD-10-CM.”

The statement “evaluation and treatment by a new physician” can be a source of confusion, but you will code correctly if you are able to answer the basic question, “Has the patient previously received active treatment for this condition in any setting or by any provider?”

Per this article, her take is that if the patient saw another doctor in Florida or in the ER for a foreign body in their eye and are now seeing you as a follow-up , then it would be coded as subsequent, not initial based on new versus established patient guidelines.  This is different from my 2014/2015 ICD-10 classes and the recorded training. Based on this new information, I am revising my opinion on this pending any confirmation by Medicare or other official sources (AHA, AHIMA).

I was not able to get any additional confirmation or determine if other information was used to determine this interpretation.

However, per the article, if the patient did not receive active treatment (e.g., remove the foreign body) then this encounter would be the initial, not subsequent. So there is some grey area here. The key is to be consistent in your interpretation among doctors and staff.

The rest of the article explains active treatment:

For example: The patient is evaluated in the emergency room (ER) for a displaced transverse fracture of the left ulna that cannot be managed at this time. The ER applies immobilization and ice and instructs the patient to follow up with orthopedics in the morning. This would be reported using S52.222A Displaced transverse fracture of the left ulna, initial encounter for closed fracture.

When the orthopedist rechecks the patient and reduces the fracture the next day, the patient is receiving initial active treatment for this fracture. That is, this is the first encounter at which the patient receives definitive care (the ER was able to apply comfort care only). Per ICD-10 guidelines, you would again report S52.222A for an initial encounter.

Usage of XA or XD hinges on interpretations of “active treatment” and “definitive” care. If the ER doctor removed two FB from the patient’s eye  but on the subsequent visit to the OD, another FB particle is found and removed, is that an initial or subsequent visit? Based on the interpretation above, I would now code it as subsequent–the patient did receive a foreign body removal service. Think of subsequent as “aftercare” regardless of whether you continue with the treatment or simply monitor it.

For those who know me, I always defer to official sources and I  confirm whether what I am stating is based on my professional opinion or a specific source. Sometimes there is very little official documentation to follow.

I will continue to monitor the definitions and usage of “initial” versus “subsequent” and send my findings to all the EyeCodingForum ICD-10 clients. I will post findings to my website as well. The complete guidelines are below:

icd10cm_guidelines_2014

Jeffrey Restuccio, CPC, CPC

July 31 2015 ICD-10 Coding Exercises for Eyecare

July 31 2015 list of ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet. Click on the link below to download the PDF.

July 31 2015 12 coding exercises

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

Click Here to Order EyeCodingForum Services.

Jeffrey Restuccio, CPC, CPC.

Exercise List is below:

Code for a benign neoplasm of left conjunctiva
Report DM type 1 with high A1C (greater than 8)
Report a blepharospasm
Code for allergic conjunctivitis of both eyes
Code simple episcleritis of the right eye
Report an after-cataract that is not obscuring vision, right eye
Report drusen of the macula, right eye
Code a glaucoma suspect, bilateral
Report myopia of both eyes:
Report a routine exam of the eyes for a vision plan w/o abnormal findings.
Code for a screening for long term plaquenil use:
On the fee ticket, the provider documents “cataract.”

July 24 ICD-10 coding exercises for optometry and ophthalmology

July 24 2015: Every week the EyeCodingForum will be posting ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet). Click on the image below to print it full-size.

ICD-10 exer 1 July 27 2015 20 codes

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

Click Here to Order Services.

ICD-10 coding exercises for optometry and ophthalmology.

 

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1

Report viral conjunctivitis. Enter code in the boxes=>

2

Report DM type 1 controlled

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Dry eye syndrome of both eyes

4

Report dry ARMD of the right eye:

5

Code POAG:

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Report hyperopia of both eyes:

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Code for amblyopia of the right eye:

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The patient presents with pain in the right eye:

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Code for essential (primary) hypertension

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Code for tobacco use:

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Code for a benign neoplasm of rt conjunctiva:

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Code ptosis of the right upper eyelid:

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Report unspecified keratitis of both eyes:

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Code ocular HTN:

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Code astigmatism:

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Report presbyopia of both eyes

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The patient has blurred vision of both eyes

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The patient presents with red eyes

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Code for a follow up visit for a FB in cornea, left eye

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Code for pseudophakia

2015 example of a GEMS ICD-9 to ICD-10 conversion

for ophthalmology and optometry. If you want your codes converted, create a report from your practice management system sorted by quantity (so we can determine your top 100 codes.)

Sample $500 ICD-9 to ICD-10 conversion list

 

ICD-10 Implementation Plan for Eyecare

This free, three-page implementation is a succinct outline of an action plan for preparing for the October 1 ICD-10 deadline.

It is suitable for optometry and ophthalmology offices. It includes:

  1. Overview
  2. Action Items
  3. New to ICD-10 Concepts
  4. What to review starting now
  5. Data entry practice recomendations
  6. Basics
  7. ICD-10 concept review
  8. Reporting 2 codes when required (this is covered in detail in my ICD_10 training course)
  9. Documentation issues pertaining to specific diseases (covered in my online, recorded course)
  10. Injury coding
  11. Top 10 codes/code groups most clinics omit.
  12. List of six actual omitted codes
  13. 42 questions posted separately on the EyeCodingForum

Click on this link to enter  your information and download the free, three-page implementation form.

Click Here to Order EyeCodingForum Services