Adjusting to the ICD-10 is a challenge for any medical billing office, but one requirement that optometrists and ophthalmologists is particularly important: a glaucoma diagnosis is not simply a glaucoma diagnosis.
Under the new ICD-10 requirements, glaucoma stage must be documented to code accurately with ICD-10. Under ICD-9 guidelines, a diagnosis of glaucoma often focused on the type of glaucoma (primary open angle, closed angle, congenital, traumatic, etc.), but the ICD-10 guidelines want doctors and their billing staffs to add a bit more information to the diagnosis code.
That is, according to the American Academy of Ophthalmology, the new system requires a seventh digit for glaucoma diagnoses. The final digit focuses on the stage that the glaucoma is in. For example, if the patient is exhibiting mild or early stage glaucoma, the seventh digit for the ICD-10 would be a 1.
Mild or Early Stage Glaucoma
The AAO and American Glaucoma Society defines mild or early stage glaucoma as demonstrating the optic nerve abnormalities associated with glaucoma, but no current impact on the visual field. Only patients without visual abnormalities or with “abnormalities present only on short-wavelength automated perimetry or frequency doubling perimetry” would qualify as having mild or early stage glaucoma.
In this situation, the seventh digit “1” would be paired with the code for the type of glaucoma that the patient is exhibiting. For example, using the AAO’s Glaucoma Quick Reference Guide, a patient with early stage open angle glaucoma with borderline findings and low risk (one or two risk factors) would be coded as H40.011X1 for the right eye and H40.012X1 for the left eye.
The coding pattern follows through with the various stages of glaucoma.
Moderate Stage Glaucoma
If the patient is demonstrating optic nerve abnormalities consistent with glaucoma and glaucomatous visual field abnormalities in one hemifield and not within 5 degrees of fixation, then they are demonstrating what the AAO considers moderate stage glaucoma.
Moderate stage glaucoma is noted with a “2” as the final digit in the diagnosis code. As in the example above, moderate stage open angle glaucoma with borderline findings and low risk the ICD-10 code would be H40.011X2 for the right eye and H40.012X2 for the left eye.
Advanced, Late or Severe Stage
The AAO defines late or severe stage glaucoma as optic nerve abnormalities consistent with glaucoma, glaucomatous visual field abnormalities in both hemifields and/or loss within 5 degrees of fixation in at least one hemifield. This stage uses the marker 3 in the seventh slot as its designation within the diagnosis code. Advanced stage open angle glaucoma with borderline findings would be H40.011X3 and H40.012X3 for the right and left eyes respectively.
There are also ICD-10 codes meant to help with billing when the glaucoma stage cannot be determined or has not been documented.
For various reasons, there are some cases when the glaucoma stage either has not yet been determined or cannot be determined. For patients who are incapable of completing a visual field test, those who have not yet had time to complete a visual field test or those whose visual field was unreliable, ICD-10 asks that “4” be used as the seventh digit. Using our continuing example, a patient who has not yet completed the visual field, but has open angle glaucoma with borderline findings would be coded H40.011X4 or H40.012X4. If both eyes were impacted, the code would be H40.013X4.
For patients with unspecified stage glaucoma, the seventh digit should be listed as zero, as in H40.011X0. The AAO reminds medical providers that documenting the glaucoma stage in the medical record is important for both billing and monitoring patient treatment and the disease’s progress.
How this differs from ICD-9
According to the AAO, the primary differences between ICD-9 and ICD-10 for glaucoma billing is that some billing codes do not have a laterality digit. In those cases, the seventh digit to designate stage is required. When designating the glaucoma stage, the most advanced eye stage should be used for both eyes. That is, if a patient has moderate stage glaucoma in the right eye and early stage glaucoma in the left, both eyes should be coded as stage 2.
For assistance in converting ICD-9 codes to ICD-10, this site allows you to look up the old diagnosis code and click a link to convert it to ICD-10. For example, if you previously would have coded your patient’s diagnosis as 365.11 (primary open angle glaucoma), the site will tell you that the new option is H40.011X0 for unspecified and so forth. This can be a very helpful site for medical staff members who previously memorized ICD-9 codes.
Which codes require the 7th digit?
The primary three codes which no longer have laterality codes and require a 7th digit are: H40.011, H40.010, and H40.020. Two codes which you may use frequently that do not require the seventh digit are: H40.89 and H40.9 for other specified glaucoma and unspecified glaucoma respectively.
Advantage Administration, Inc. specializes in helping medical practices reach optimal financial and operational efficiency. A smooth transition to ICD-10 is just one piece of an efficient practice management strategy. Find out more about how our practice assessment can help your office through some of the biggest changes health care has seen in decades. For more information on ICD-10 implementation and available resources, contact our billing and collections team at Agnite Health LLC at 844.318.2150.
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