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New ICD-10 Reminders and Updates

Posted by Janelle Pauli on Oct 3, 2016 2:43:00 PM
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When ICD-10 was introduced last year a code freeze was put in place to help providers adjust and ease into such a big change. Now, a year later, the code freeze has been lifted and hundreds of new code additions, changes, and deletions have been put into place starting on October 1, 2016.

In this post we'll review a few things you need to know about ICD-10 codes and their structure, and we'll get into some of the specifics of what is changing and provide some great resources for you to get all the details on specific code lists and changes.

ICD-10 Changes You Need to Know About

A Reminder on Code Structure

  • Codes are 3-7 characters in length
  • 1st Character = alpha
  • 2nd Character = numerical
  • 3rd - 7th Character = alpha or numerical
  • Decimal after the first three characters
  • Alpha characters are not case sensitive
  • Dummy placeholder "x" is sometimes used for 7th character

ICD-10 Terminology and Conventions, Tabular List StructureICD-10 Updates

Tabular list > Chapters > Body System/Condition
From here the list is divided into categories, subcategories, and codes. Providers can only report codes. 

Categories: 3 characters (if there is no further subcategory, it is equivalent to code)

Subcategories: 4-5 characters (each level of subdivision after a category is a subcategory, and if no further subdivision is required it is equivalent to code)

Codes: 3, 4, 5, 6, or 7 characters (final level of subdivision. If placeholder is needed, use "x" for code to be valid)

Tabular List Example

H35 Other Retinal Disorders [Category]

Excludes2: diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)

H35.32: Exudative age related macular degeneration [Subcategory, not a code]

One of the following 7th characters is to be assigned to codes in subcategory H35.32 to designate the stage of the disease:

0 = Stage Unspecified (non-billable)
1 = with active choroidal neovascularization
2 = with inactive choroidal neovascularization, or with involuted or regressed neovascularization
3 = with inactive scar

H35.321: Exudative age related macular degeneration, right eye [Final Code]

H35.322: Exudative age related macular degeneration, left eye [Final Code]

H35.323: Exudative age related macular degeneration, bilateral [Final Code]

H35.329: Exudative age related macular degeneration, unspecified eye [Final Code]

H32.33: Angioid streaks of macula [Subcategory that is a code]

Changes as of October 1, 2016

Some of the changes that will affect codes more commonly used in your practice include the following:

  • Diabetes 
  • Dry ARMD 
  • Wet ARMD
  • Glaucoma
  • CRVO
  • BRVO
  • Amblyopia
  • Post Procedural

One of the biggest changes we think will affect eyecare providers is with unspecified codes which are mostly non-billable. You've likely been using some of these codes over the past year and have been able to get paid, but with the change, payers could begin rejecting claims for unspecified or non-billable codes. Providers will be required to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. A few codes we think are most important to note are:

  • H34.811
  • H34.812
  • H34.813
  • H34.819
  • H34.831
  • H34.832
  • H34.833
  • H34.839
  • H35.31
  • H35.32
  • H40.11X0
  • H40.11X1
  • H40.11X2
  • H40.11X3
  • H40.11X4

In order to see the complete list of code changes we suggest checking out some of the following resources:

CMS.gov

CDC.gov

AOA.org

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Topics: ICD-10, Biller

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