ICD-10 Update: The Year of The Eyelid

Brett Paepke, OD

Director of ECP Services, Rev360

Ask people here in the northeast part of the country to name their favorite season of the year and you’re likely to hear many pick fall. Something about the leaves changing, the World Series, and planning for the upcoming ski and hockey seasons get people really excited. A well-kept secret, though, is that what people really love most about the fall is the annual update to the ICD-10 code set.

OK. Maybe that’s not entirely (or even remotely) true. But as ODs, we’ve come to expect these changes each fall since ICD-10 was implemented in the United States. As a quick recap, the year was 2015: NASA confirmed the presence of water on Mars, a new Star Wars movie was released nearly 30 years after the very first, and the US Department of Health and Human Services announced that ICD-10 would be delayed no further. October 1, 2015 was declared the day of implementation. Great anxiety about the transition gripped the health care world, but I think most would agree that with a little bit of education and associated assistance from EHRs, the transition was relatively painless.

ICD-10 offers us greater specificity than ICD-9 did and, in turn, allows health care systems to better track what conditions they’re managing, how diseases interrelate, etc. With that specificity comes many more available codes. There were around 13,000 ICD-9 codes in 2015 and, at the time of implementation, there were around 68,000 ICD-10 codes. That number has since grown to nearly 72,000.

Why? Each year a review panel meets multiple times to review stakeholder feedback about codes that should be added, removed, or edited and ultimately decides on the changes to be implemented on October 1 of that year. You’ll remember in 2016 we saw high number of additions including new codes for glaucoma, AMD, and diabetic retinopathy. 2017 brought us fewer changes but involved adding new codes for degenerative myopia and low vision.

The changes to take effect on October 1, 2018 have officially been released and I think it’s fair to call it the “year of the eyelid”. The key edits:

  • Meibomian gland dysfunction codes are finally here! Gone will be the discussions in online forums of “creative” ways to code for this condition and you’ll now be able to accurately represent the condition with codes
  • New codes to represent rosacea conjunctivitis
  • The ability to better specify the involved eyelids for a number of conditions has been added. Many dreaded the scenario of a patient having blepharitis of both upper and lower lids in each eye because it meant four codes needed to be added to the record. This year’s update provides the ability to add a code such as “Squamous blepharitis right eye, upper and lower eyelids”
  • Codes for paralytic forms of entropion have been added to supplement the already existing etiologies of cicatricial, mechanical, senile, spastic, and unspecified
  • Terminology edits to epiphora codes. Traditionally, these have referenced the lacrimal gland (i.e. “Epiphora due to insufficient drainage, right lacrimal gland”) but will not moving forward (i.e. “Epiphora due to insufficient drainage, right side”)

As we’ve done since the very first of these annual updates, we’ve prepared a guide of the eye-specific changes taking effect this year to give you a quick resource to reference in your preparation. Note that the document contains three columns: Action, Code, and Description. The “Action” column describes what is happening to the code to the right of it and will contain “Delete”, “Add”, “Revise from”, or “Revise to”. Each area of change is also grouped together to allow easier visualization of codes replacing other ones. We hope you find this resource helpful.

CLICK HERE to download our ICD-10 Update Guide

Learn more about Dr. Brett Paepke.


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