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Healthcare News: Note the revised ICD-10-CM guidelines for glaucoma

JustCoding News: Outpatient, January 25, 2012

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Coders who are preparing for the upcoming transition to ICD-10-CM should note some significant changes to the coding guidelines for glaucoma coding as part of the 2012 updates to the ICD-10-CM Official Guidelines for Coding and Reporting.

The guidelines instruct coders to assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, the affected eye, and the glaucoma stage.

Note the following guidelines:

  • When a patient has bilateral glaucoma and the physician documents both eyes as being the same type and stage, and a code for bilateral glaucoma exists, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.
  • When a patient has bilateral glaucoma and the physician documents both eyes as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e., subcategories H40.10, H40.11, and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage.
  • When a patient has bilateral glaucoma and the physician documents that each eye has a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma.
  • When a patient has bilateral glaucoma and the physician documents that each eye has a different type, and the classification does not distinguish laterality, assign one code for each type of glaucoma with the appropriate seventh character for the stage.
  • When a patient has bilateral glaucoma and the physician documents that each eye has the same type, but different stage, and the classification does not distinguish laterality, assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye.
  • When a patient is admitted with glaucoma and the stage progresses during the admission, assign the code for highest stage documented.

Assignment of the seventh character “4” for “indeterminate stage” should be based on the clinical documentation. The seventh character “4” is used for glaucomas with a stage that cannot be clinically determined. This seventh character should not be confused with the seventh character “0” for “unspecified”, which coders should assign when there is no documentation regarding the stage of the glaucoma.

Coders can review all of the guideline changes as well as the updated ICD-10-CM codes online at the Centers for Disease Control and Prevention website. Narrative charges are in bold.
 



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