New ICD.9 Codes - Effective 10/1/2011 Hot

 New ICD.9 Codes - Effective 10/1/2011

This is breaking news that you can use. There are new ICD.9 codes and guidelines relating to billing for glaucoma that go into effect October 1, 2011. The following is the information you and your billing specialist will need.

The list of new codes is found here. The coding of glaucoma has changed. Follow the instructions for each step to code properly.

173.10    Unspecified malignant neoplasm of eyelid, including canthus
173.11    Basal cell carcinoma of eyelid, including canthus
173.12    Squamous cell carcinoma of eyelid, including canthus
173.19    Other specified malignant neoplasm of eyelid, including canthus
365.05    Open angle with borderline findings, high risk
365.06    Primary angle closure without glaucoma damage
365.70    Glaucoma stage, unspecified
365.71    Mild stage glaucoma (early)
365.72    Moderate stage glaucoma
365.73    Severe stage glaucoma (advanced, end-stage)
365.74    Indeterminate stage glaucoma
379.27    Vitreomacular adhesion
V19.11    Family history of glaucoma
V19.19    Family history of specified eye disorder

Revised ICD.9 Codes - Effective 10/1/2011
365.01   Open angle with borderline findings, low risk

Deleted ICD.9 Codes - Effective 10/1/2011
173.1      Other malignant neoplasm of skin eyelid, including canthus
V19.1      Family history of other eye disorders

The new ICD-9 codes allow staging of glaucoma into mild, moderate, and severe disease based simply on the physician’s analysis of the printout of the visual field in the patient’s worse eye.
It is important to document the stage in the patient’s medical record. However, while the new staging definitions must be used after October 1, 2011, they will not impact coverage, as current policies link to the primary diagnosis.

Step One: Code by Type
To get started, first code the type of glaucoma (only those listed below require the add-on staging codes):
365.10     Open angle glaucoma, unspecified
365.11     Primary open angle glaucoma
365.12     Low-tension glaucoma (also use for normal tension glaucoma)
365.13     Pigmentary glaucoma
365.20     Primary angle closure glaucoma, unspecified
365.23     Chronic or primary angle closure glaucoma (angle damage plus optic nerve damage)
365.31     Steroid induced glaucoma
365.52     Pseudoexfoliation glaucoma
365.62     Glaucoma associated with ocular inflammations
365.63     Glaucoma associated with vascular disorders
365.65     Glaucoma associated with ocular trauma

Step Two: Add Stage
Second, determine the severity of the glaucoma in the worst eye, based on the new ICD-9 staging definitions:  (* represents new code)
*365.71     Mild or early-stage glaucoma (defined as optic nerve abnormalities consistent with glaucoma but no visual field  on any white –on-white visual field test, or abnormalities present only on short-wavelength doubling perimetry)
*365.72      Moderate stage glaucoma (optic nerve abnormalities consistent with glaucoma and glaucomatous visual field abnormalities in one hemifield, and not within 5 degrees of fixation)
*365.73     Severe stage glaucoma, advanced stage glaucoma, end stage glaucoma (Optic nerve abnormalities consistent with glaucoma and glaucomatous visual field abnormalities in both hemifields, and/or loss within 5 degrees of fixation in at least one hemifield)
*365.74     Indeterminate (visual fields not performed yet, or patient incapable of visual field testing, or unreliable/uninterpretable visual field testing)
*365.70     Unspecified, stage not recorded in chart

Open angle glaucoma suspects (based on the number of risk factors: family history, race, elevated IOP, optic disc appearance and thin central corneal thickness):
365.01 Open angle suspect, low risk (one or two risk factors)
*365.05 Open angle suspect, high risk (three or more risk factors)

Angle closure borderline/suspects
365.02 Primary angle closure suspect (anatomical suspect, narrow angle)
*365.06 Primary angle closure without glaucoma damage (defined as angle damage such as peripheral anterior synechiae or high IOP, but without optic nerve damage)

Primary angle closure
*365.23 Chronic angle closure glaucoma (angle nerve damage plus optic nerve damage

 ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 35 of 107

6. Chapter 6: Diseases of Nervous System and Sense Organs (320-389)
b. Glaucoma
1) Glaucoma
For types of glaucoma classified to subcategories 365.1-365.6, an additional code should be assigned from subcategory 365.7, Glaucoma stage, to identify the glaucoma stage. Codes from 365.7, Glaucoma stage, may not be assigned as a principal or first-listed diagnosis.

2) Bilateral glaucoma with same stage
When a patient has bilateral glaucoma and both are documented as being the same type and stage, report only the code for the type of glaucoma and one code for the stage.

3) Bilateral glaucoma stage with different stages
When a patient has bilateral glaucoma and each eye is documented as having a different stage, assign one code for the type of glaucoma and one code for the highest glaucoma stage.

4) Bilateral glaucoma with different types and different stages
When a patient has bilateral glaucoma and each eye is documented as having a different type and a different stage, assign one code for each type of glaucoma and one code for the highest glaucoma stage.

5) Patient admitted with glaucoma and stage evolves during the admission
If a patient is admitted with glaucoma and the stage progresses during the admission, assign the code for highest stage documented.

 6) Indeterminate stage glaucoma
Assignment of code 365.74, Indeterminate stage glaucoma, should be based on the clinical documentation. Code 365.74 is used for glaucomas whose stage cannot be clinically determined. This code should not be confused with code 365.70, Glaucoma stage, unspecified. Code 365.70 should be assigned when there is no documentation regarding the stage of the glaucoma.

If you would like a copy of these codes, please open and print the attachments below. Thank you to Walt Mayo and Optcomlist for providing some of this information.

Attachments:

File	Description	File size	Last modified
ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011		177 Kb	10/04/11 15:21
New ICD.9 Codes - Effective 10.1.2011.pdf		442 Kb	10/01/11 13:12