ICD-10 Coding for Ophthalmology

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

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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Cite this: ICD-10 Coding for Ophthalmology - Medscape - Feb 21, 2014.