Last year, the U.S. healthcare community worked hard to switch from ICD-9 to ICD-10. To ease the transition, the Centers for Medicare and Medicaid Services (CMS) granted a 1-year grace period for ICD-10 flexibility, during which providers could code with high-level codes without fearing an audit. On October 1st 2016, this grace period ended. In addition, CMS introduced 1,900 new ICD-10 diagnosis codes, which include a number of code additions and modifications.
But what do these ICD-10 changes mean for your optometry practice?
Not as much as some people might fear. Let’s talk about it.
In terms of the ICD-10 code additions and modifications, only about 750 of those new 1,900 codes affect optometry. And a lot of those changes make sense and have been anticipated by the eye care community. For example, whereas previously macular degeneration and open angle glaucoma had no left/right eye designation, the latest ICD-10 updates allow providers to include appropriate laterality codes. So, as you diagnose your patients, you will find the expanded ICD-10 base most likely beneficial and not cumbersome.
In terms of coding flexibility, nothing really has changed. With the initial introduction of ICD-10 in 2015, providers should have already coded on the highest level of specificity to accurately reflect their exam documentation. For example, if you diagnose a patient with Myopia, the ICD-10 code you select should also specify laterality since this is information you know and documented in the chart.
However, in instances where you don’t have enough information available to determine a more specific code, an unspecific code is applicable and totally acceptable. Really, the only thing that has changes with the October 1st, 2016 deadline is that insurances can now hold you accountable for not choosing specific codes where clinical documentation warrants specificity. Whereas, during the grace period, insurances could not investigate and/or deny claims solely on the basis of code specificity. So, the number of audits might increase for those providers who diagnose the majority of their exams with unspecific codes. But again, if you base your coding on all the details of your documentation, you have nothing to worry about.