2019 ICD-10 Updates for Ophthalmology and Gastroenterology

The Centers for Disease Control and Prevention (CDC) released the ICD-10 code changes for 2019 on June 11, 2018. The 473 ICD-10 code changes published for the upcoming year are applicable to all hospital inpatient and outpatient coding from October 1, 2018 through September 30, 2019. These include – 279 new ICD-10 codes, 143 revised codes and 51 deleted codes focused primarily around the theme of increased specificity. To ensure accurate claim submissions, it is imperative for healthcare practices and medical billing and coding companies to take note of these coding updates and get familiar on how to use the new codes correctly.

According to “Elana Oberstein” – MD and Medical Director of Musculoskeletal, “The new 2019 ICD-10 additions helped add more specificity for the classifications of certain conditions”. For instance, if we are taking a condition “muscular dystrophy”, it is possible to detail major forms of the condition like – Myotonic (also called MMD or Steinert’s disease), Duchenne, Becker, Limb-girdle or congenital muscular dystrophy. This level of granularity can help improve the documentation process and thus have a better understanding of specific patient conditions.

FY 2019 ICD-10 includes several code changes for Ophthalmology (Chapter 7: Diseases of the Eye and Adnexa –specifies upper or lower lids) and Gastroenterology (Chapter 11: Diseases of the Digestive System).

Here are some key coding updates of interest to Ophthalmology medical coding service providers, as reported by the American Society of Ophthalmic Administrators –

The 2019 ICD-10 updates include changes to codes for the following eye conditions –

• Blepharitis
• Meibomian gland dysfunction
• Paralytic ectropion
• Lagophthalmos
• Rosacea conjunctivitis
• Brow ptosis
• Other specified disorders of eye and adnexa

The code changes generally include new specifications for both upper and lower eyelids. Other revisions, simply involve adding a specification for the eye as – right, left or bilateral.

Here is a list of new codes added to Chapter 7 – Diseases of the Eye and Adnexa (of the existing series) –

Paralytic Ectropion of Eyelid

H02.15 – Paralytic ectropion of eyelid

• H02.151 – Paralytic ectropion of right upper eyelid
• H02.152 – Paralytic ectropion of right lower eyelid
• H02.153 – Paralytic ectropion of right eye, unspecified eyelid
• H02.154 – Paralytic ectropion of left upper eyelid
• H02.155 – Paralytic ectropion of left lower eyelid
• H02.156 – Paralytic ectropion of left eye, unspecified eyelid
• H02.159 – Paralytic ectropion of unspecified eye, unspecified eyelid

Meibomian Gland Dysfunction – This is a new category of ICD-10 codes which CMS has placed under H.02.8.

H02.88 – Meibomian gland dysfunction of eyelid

• H02.881 – Meibomian gland dysfunction right upper eyelid
• H02.882 – Meibomian gland dysfunction right lower eyelid
• H02.883 – Meibomian gland dysfunction of right eye, unspecified eyelid
• H02.884 – Meibomian gland dysfunction left upper eyelid
• H02.885 – Meibomian gland dysfunction left lower eyelid
• H02.886 – Meibomian gland dysfunction of left eye, unspecified eyelid
• H02.88A – Meibomian gland dysfunction right eye, upper and lower eyelids
• H02.88B – Meibomian gland dysfunction left eye, upper and lower eyelids

Blepharitis

Unspecified Blepharitis

• H01.00A – Unspecified blepharitis right eye, upper and lower eyelids
• H01.00B – Unspecified blepharitis left eye, upper and lower eyelids

Ulcerative Blepharitis

• H01.01A – Ulcerative blepharitis right eye, upper and lower eyelids
• H01.01B – Ulcerative blepharitis left eye, upper and lower eyelids

Squamous Blepharitis

• H01.02A – Squamous blepharitis right eye, upper and lower eyelids
• H01.02B – Squamous blepharitis left eye, upper and lower eyelids

Paralytic Ectropion of Eyelid

• H02.151 – Paralytic ectropion of right upper eyelid
• H02.152 – Paralytic ectropion of right lower eyelid
• H02.153 – Paralytic ectropion of right eye, unspecified eyelid
• H02.154 – Paralytic ectropion of left upper eyelid
• H02.155 – Paralytic ectropion of left lower eyelid
• H02.156 – Paralytic ectropion of left eye, unspecified eyelid
• H02.159 – Paralytic ectropion of unspecified eye, unspecified eyelid

Lagophthalmos

Unspecified Lagophthalmos

• H02.20A – Unspecified lagophthalmos right eye, upper and lower eyelids
• H02.20B – Unspecified lagophthalmos left eye, upper and lower eyelids
• H02.20C – Unspecified lagophthalmos, bilateral, upper and lower eyelids

Mechanical Lagophthalmos

• H02.22A – Mechanical lagophthalmos right eye, upper and lower eyelids
• H02.22B – Mechanical lagophthalmos left eye, upper and lower eyelids
• H02.22C – Mechanical lagophthalmos, bilateral, upper and lower eyelids

Paralytic Lagophthalmos

• H02.23A – Paralytic lagophthalmos right eye, upper and lower eyelids
• H02.23B – Paralytic lagophthalmos left eye, upper and lower eyelids
• H02.23C – Paralytic lagophthalmos, bilateral, upper and lower eyelids

Rosacea Conjunctivitis

Under code H10.82 – Rosacea conjunctivitis, new codes for right eye, left eye, bilateral and unspecified rosacea conjunctivitis have been added.

• H10.821 – Rosacea conjunctivitis, right eye
• H10.822 – Rosacea conjunctivitis, left eye
• H10.823 – Rosacea conjunctivitis, bilateral
• H10.829 – Rosacea conjunctivitis, unspecified eye

Browptosis

• H57.811 – Brow ptosis, right
• H57.812 – Brow ptosis, left
• H57.813 – Brow ptosis, bilateral
• H57.819 – Brow ptosis, unspecified

Other specified disorders of eye and adnexa

• H57.89 – Other specified disorders of eye and adnexa

New Code Additions for Gastroenterology

Chapter 11 – Diseases of the Digestive System – includes 15 new codes which describe a breakout of generalized versus localized peritonitis in association with acute appendicitis – additionally five deleted codes and one revised.

Appendicitis refers to an inflammation of the appendix (a closed tube of tissue attached to the large intestine) in the lower right abdomen. It may be acute or chronic and causes pain in your lower right abdomen.

New Codes for Appendicitis

K352 (Acute appendicitis with generalized peritonitis) was deleted and replaced with –

• K3520 – Acute appendicitis with generalized peritonitis, without abscess
• K3521 – Acute appendicitis with generalized peritonitis, with abscess

K353 (Acute appendicitis with localized peritonitis) was deleted and replaced with –

• K3530 – Acute appendicitis with localized peritonitis, without perforation or gangrene
• K3531 – Acute appendicitis with localized peritonitis and gangrene, without perforation
• K3532 – Acute appendicitis with perforation and localized peritonitis, without abscess
• K3533 – Acute appendicitis with perforation and localized peritonitis, with abscess

K3589 (Other and unspecified acute appendicitis) was deleted and replaced with –

• K35890 – Other and unspecified acute appendicitis, without perforation or gangrene
• K35891 – Other and unspecified acute appendicitis, without perforation, with gangrene

Ischiorectal Abscess

• K61.31 – Horseshoe abscess
• K61.39 – Other ischiorectal abscess
• K61.5 – Supralevator abscess

K80 – Cholelithiasis Series – Use Additional code if applicable for associated gangrene of gallbladder (K82.A1), or perforation of gallbladder (K82.A2).

Disorders of Gallbladder in diseases classified elsewhere

• K82.A1 – Gangrene of gallbladder in cholecystitis
• K82.A2 – Perforation of gallbladder in cholecystitis

Cholangitis

• K83.01 – Primary sclerosing cholangitis
• K83.09 – Other cholangitis

The above mentioned FY 2019 ICD-10 updates for Ophthalmology and Gastroenterology already came into effect on October 1 as there is no grace period provided for implementation.

Managing ophthalmology and gastroenterology medical billing and coding can be made much easier for physicians who partner with an experienced medical billing and coding service provider. Coders in reliable medical coding companies need to be well prepared to help ophthalmologists and gastroenterologists ensure accurate diagnosis reporting with the new code sets.