Like most eye care practices, you likely treat patients with co-morbid conditions. The patient population of many practices is often older than average, and many times chronically ill. So, correctly coding for co-morbidity is essential in avoiding costly revenue leaks that could drain cash from your practice.
New Options for DKA Coding
Recent studies have shown that the number of type 2 patients presenting with diabetic ketoacidosis has been increasing, and that’s one reason for the new DKA codes.
Prior to the 2018 revisions, the best coding option to describe a patient with type 2 DKA was E11.69 (Type 2 diabetes mellitus with other specified complication).
Beginning October 1, 2017, you’ll see a new subdivision among the E11 (Type 2 diabetes mellitus) codes: E11.1 (Type 2 diabetes mellitus with ketoacidosis). This new subdivision includes two codes:
- E11.10 (… without coma)
- E11.11 (… with coma).
Other DKA-related additions occur in the following code series:
E08 — (Diabetes mellitus due to underlying condition)
E09 — (Drug or chemical induced diabetes mellitus…)
E10 — (Type 1 diabetes mellitus …)
E13 — (Other specified diabetes mellitus …)
All four series contain XXX.1 (… with ketoacidosis) as a subdivision containing two codes:
- XXX.10 (… without coma)
- XXX.11 (… with coma).
Updates for Coding Medical Management of Diabetes
General guidelines for coding diabetes mellitus and secondary diabetes mellitus instruct coders how to report the medical management of diabetes. The ICD-10-CM Official Guidelines for Coding and Reporting are available here. You’ll find the first revisions in bold under Chapter 4.a.1, ‘Diabetes mellitus and the use of insulin and oral hypoglycemics’:
“An additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs. If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.”
Similar instructions appear shortly afterwards for secondary diabetes mellitus. Z79 is the “Long term [current] drug therapy series.”
In Chapter 7: Diseases of the Eye and Adnexa, Disorders of the Globe, you’ll see a change to H42 (Glaucoma in diseases classified elsewhere). The manual deletes the old “excludes 2” note for glaucoma in diabetes mellitus and replaces it with an instructional note for appropriate sequencing that follows familiar coding conventions. The new note reads:
“Code first glaucoma (in) diabetes mellitus (E08.39, E09.39, E10.39, E11.39, E13.39).”
Degenerative Myopia Codes Gain Specificity
You’ll find the following new subcategories under H44.2 to code for degenerative myopia and associated conditions:
H44.2A — Degenerative myopia with choroidal neovascularization
H44.2B — Degenerative myopia with macular hole
H44.2C — Degenerative myopia with retinal detachment
H44.2D — Degenerative myopia with foveoschisis
H44.2E — Degenerative myopia with other maculopathy
These are combination codes, so if you choose one from this group, make sure there is enough clinical documentation in the medical record to support your choice. If your clinicians use templates, the template should remind them to document any complications or manifestations associated with the condition that is present along with the degenerative myopia.
When working with these codes, report laterality with the sixth character as follows:
Right eye: 1
Left eye: 2
ICD-10 gives you the option to use sixth character 9 to report “unspecified eye.” As always, please don’t use these “unspecified” codes because specifying laterality is the best practice for clean claims. As a safeguard, consider asking your EHR vendor to eliminate any ‘unspecified’ codes associated with laterality as a code choice.
Coding to the highest possible level of specificity has an added benefit: As MACRA, MIPS, quality reporting, and value-based reimbursement gain traction, specific, accurate coding ensures that Medicare and other payers have data that is accurate for your eye care practice.
Read the complete list of ICD-10-CM changes here.
Attending the American Academy of Ophthalmology’s annual meeting in New Orleans? I’ll be teaching a session called “Strategic Documentation, Compliance, and Revenue Cycle.”
DATE: Monday, November 13th
TIME: 10:15-11:15 AM
LOCATION: Morial Convention Center, Room 296