Posts tagged ‘glaucoma’

August 11, 2011

New guidelines are here!

Coding Guidelines were released today, effective Oct. 1, and it does not appear there is anything earth-shattering. With the new glaucoma codes have come a slew of new glaucoma guidelines. Here are some highlights:

Glaucoma additions break out guidelines for glaucoma 365,1-365.7, then breaks the guidelines out by: bilateral glaucoma with same stage, bilateral glaucoma stage with different stages, bilateral glaucoma with different types and different stages, patient admitted with glaucoma and stage evolves during the admission, and undetermined glaucoma stage. (Chapter 6.b)

There is a slight change in the wording of Late effects:
“A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first.    The late effect code is sequenced second.

Exceptions to the above guidelines are those instances where the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s) or the classification instructs otherwise. The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect.” (Section 1.B.12)

Septic shock (Chapter 1.b.6.a, Chapter 1.b.6.b) include additions for sceptic shock codes:
785.52, Septic shock or 998.02, Postoperative septic shock.

Postprocedural infection and postprocedural septic shock changes address postprocedural infection and complications. Codes involved include: 998.59, 674.3x, 995.92, 998.02. (Chapter 1.10)

Anemia associated with malignancy. There is a clause addition to this area of the guidelines. “If anemia in neoplastic disease and anemia due to antineoplastic chemotherapy are both documented, assign codes for both conditions.” (Chapter 2.c.1)

Complications of care (Chapter 17.f.1) specifies that An additional code identifying the complication should be assigned with codes in categories 996-999, Complications of Surgical and Medical Care NEC, when the additional code provides greater specificity as to the nature of the condition.

July 6, 2011

Eye and adnexa, ear and mastoid cover two ICD-10 chapters

Another posting on ICD-10 just to get everyone a little more familiar with the way codes work!

ICD-9 lumps Diseases of the Nervous System and Sense Organs into one chapter, Chapter 6. The specificity of ICD-10, and the fact that ICD-1o groups by anatomy (What a thought! Eye diseases with other eye diseases!) mean big changes to this coding area.

ICD-10 Chapter 7 (H00-H59) deals specifically with Disease of the Eye and Adnexa; Chapter 8 (H60-H95) is devoted to the Diseases of the Ear and Mastoid Process, for example.

The organization, which plays into a logical coder’s mind, means that anatomy knowledge will become more and more important. The eye has several structure and parts from the lens (H25-H28) to conjunctiva (H10-H11) to the cornea (H15-H22, which include other parts, such as the iris) for example.

How about glaucoma? We keep getting new glaucoma codes in ICD-9, partially help map to the codes in ICD-10. Here’s the high-level view of glaucoma coding:

Glaucoma (H40-H42)

H40.  Glaucoma

H40.0 Glaucoma suspect

Ocular hypertension

H40.1 Primary open-angle glaucoma

H40.2 Primary angle-closure glaucoma

H40.3 Glaucoma secondary to eye trauma

H40.4 Glaucoma secondary to eye inflammation

H40.5 Glaucoma secondary to other eye disorders

H40.6 Glaucoma secondary to drugs

H42. Glaucoma in diseases classified elsewhere

McClanahan, Debbie

January 31, 2011

Be aware of glaucoma coding

Today is glaucoma awareness day, so let’s take a quick look at this eye disease.

The basics: Increased introcular pressure causes optic nerve damage and loss of vision, beginning with peripheral vision. Early stages of glaucoma do not have symptoms.

Most glaucomas are in Category 365, except for congenital glaucoma (743.20-743.22) and absolute glaucoma (360.42).

Two years ago, CMS removed the manifestation status of all glaucomas except 365.44, Glaucoma associated with systemic syndromes. This code is used when glaucoma is a manifestation of diabetes, as well as several other diseases.

In these cases, make sure to code the diabetes or other underlying disease first.

For congenital glaucoma, it must be documented by the physician.