Don’t Miss these 2018 ICD-10 Code Updates for Ophthalmology and Optometry

When it comes to ICD-10, the New Year begins early—new codes take effect October 1, 2017. There are lots of new codes for eye care. That means it’s time to update your systems and revise your documentation templates.

In our next few posts, we’ll make sure we cover everything you need to successfully code and bill ophthalmology and optometry services. So without further ado, let’s get this party started!

Big Numbers, Small Changes

ICD-10 2018 contains 363 new codes, 142 deletions, and more than 250 code revisions, but don’t panic when you spot these big numbers in alarmist articles or marketing teasers. Many of the changes this year are editorial—they simply correct misspelled words, fix small mistakes, or clear up minor ambiguities.

An example of a minor editorial change relevant to eye care practices is H02.0 (Trichiasis without entropion). The 2017 descriptor contained the misspelling “entropian,” so the revision this year simply corrects it.

Let’s put this and other such minor changes aside and go to the substantive changes that affect ophthalmology and optometry most. We’ve got quite a few of those this year that you’ll need to be aware of, but don’t worry—we’ll start with the small stuff.

Documentation Tips for Good Diagnosis Coding

Accurate ICD-10 coding can’t happen without thorough clinical documentation. Here are some items eye care providers should be aware of:

The medical record should always mention laterality to help coders select the correct code and avoid using ‘unspecified,’ a code choice almost certain to cause denials.

Does your patient have co-morbid conditions that affect your medical decision-making? If so, be sure to document them so that your coder can capture your thought process. Codes for co-morbid conditions help demonstrate to payers the complexity and severity of your patient’s chronic diseases.

I often work with physicians who say to me “my patients are the sickest of the sick. That’s true for many eye care providers. If you see these kinds of patients, make sure you document any co-morbid conditions that are influencing how you are thinking about their care.

Templates can help clinicians document well. When designing and revising templates for ophthalmology and optometry providers, take into account the following standardized documentation concepts:

• type
• anatomical location
• severity, laterality
• complications/manifestations
• caused by/due to
• temporal factors

Pay Attention to Instructional Notes

Experienced coders know that it’s often the little words that make the biggest differences.

Last year, the ICD-10-CM Official Guidelines for Coding and Reporting added new instructional notes for “with.” The guidelines note that “with” can be interpreted to mean “associated with” or “due to.”

Problematic Implication:

If you are working with the tabular index of ICD-10 codes and you see an indentation with the word “with,” there is an implied cause and effect relationship in the codes, whether the provider’s documentation ties the two together or not. It’s odd that last year’s coding guidelines implied links between two conditions—whether or not the medical record links the two. The situation has bothered many of us coders over the past year. We work best when things are black and white, and we don’t like to lean into the grey.

2018’s Fix:

This year’s revisions attempts to clarify the coding guidelines by adding “in” as another option besides “with.” Both “in” and “with” express “a causal relationship between the two conditions” they connect, the guidelines state. More explicit instructions follow, with FY 2018 additions in bold:

Changes to “Code Also”

Previously, the “code also” guidelines in Convention 17 acknowledge that you may need two ICD-10 codes to fully describe the condition, but they don’t tell you how to sequence them. (In contrast, a “code first” note provides explicit instructions about sequencing.) The FY 2018 guidelines add this sentence: “The sequencing depends on the circumstances of the encounter.”

All warmed up? Great! Next week, we’ll cover some more substantive changes to ICD-10 diagnosis coding, starting with low vision and blindness.

To read the complete list of ICD-10-CM changes, visit

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

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