ICD-10 Coding for Ophthalmology

A New Chapter for Eyes

Betsy Nicoletti, MS

Disclosures

February 21, 2014

In This Article

What's New in ICD-10

On October 1, 2014, a new version of diagnosis coding -- the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM)[1] -- goes into effect. A significant change for ophthalmology is a chapter (chapter 7) devoted solely to diseases of the eye and adnexa. In ICD-9, the sense organs (eye and ear) were included in the chapter on nervous conditions. Now, each has its own chapter, although codes in both chapters start with the letter H (Table 1).

Table 1. Blocks in Chapter 7 of ICD-10

Codes Eye Conditions
H00-H05 Disorders of the eyelid, lacrimal system, and orbit
H10-H11 Disorders of the conjunctiva
H15-H22 Disorders of the sclera, cornea, iris, and ciliary body
H25-H28 Disorders of the lens
H30-H36 Disorders of the choroid and retina
H40-H42 Glaucoma
H43-H44 Disorders of the vitreous body and globe
H46-H47 Disorders of optic nerve and visual pathways
H49-H52 Disorders of ocular muscles, binocular movement, accommodation, and refraction
H53-H54 Visual disturbances and blindness
H55-H57 Other disorders of the eye and adnexa
H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified

More Specificity, New Terms

ICD-10 also updates terminology to reflect current medical practices and provides some combination codes that describe 2 related conditions with a single code. Most coders have heard that in addition to greater specificity, ICD-10 has distinct codes for laterality for many conditions. In chapter 7, many conditions are listed as right eye, left eye, bilateral, or unspecified. Many conditions of the eyelids are further differentiated as affecting the right upper, left upper, right lower, or left lower eyelid. For glaucoma, a seventh character denotes the stage of the disease. Furthermore, in conformance with ICD-10 convention, postprocedural complications of eye surgeries are located in the eye chapter.

ICD-10 contains exclusions related to eye conditions, and these are listed at the beginning of the chapter. An exclusion means that the condition or disease is found in a different chapter, and that condition is not included with codes in the eye chapter. Chapter 7 exclusions are certain conditions related to the newborn period, some infections and parasitic diseases, complications of pregnancy, congenital disorders, selected diabetic and endocrine disorders, trauma, injury and poisoning, neoplasms, symptoms without a known disorder, and syphilis-related eye disorders.

The term "senile cataract" is replaced in ICD-10 with the term "age-related cataract." Cataracts are found in block H25-H28, "Disorders of lens." The term "nuclear sclerosis" is replaced with "age-related nuclear cataract." To code for cataracts, the documentation must first specify the type of age-related cataract: combined form, incipient (cortical, anterior subcapsular, posterior subcapsular polar, other incipient type), nuclear, morgagnian, other specified type, or unspecified type. There are codes for infantile and juvenile cataracts, traumatic cataracts, drug-induced cataracts, and secondary cataracts. All cataract codes indicate right, left, bilateral, and unspecified, and the documentation must identify which eye (or both) is involved. Although unspecified codes exist, a specific code should be selected.

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