4 6
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2 0 1 5
it. There is no rhyme or reason to this, so consult with your codebook
or other resources if you are unsure.
For example, in ICD-9 a central corneal ulcer was coded as 370.03.
In ICD-10 that could be coded 3 different ways: H16.011 if it's the
right eye, H16.012 in the left eye or H16.013 in both eyes. Leaving off
an additional digit, or adding one when it does not belong, may
cause a claim to be delayed or denied.
• Increased specificity. Another big change with ICD-10 is that a sur-
geon's operative reports must be much more specific than he may be
used to. For instance, glaucoma surgeons will need to identify
whether the glaucoma stage is mild, moderate or severe so it can be
coded correctly — using 7
th
digits 1, 2 and 3, respectively.
In cataract surgery, physicians will need to be much more specific in
the type of cataract being removed. Note that there are 70 options for
cataracts in ICD-10, so rather than stating "cataracts" as the diagnosis,
the surgeon's chart and reports must accurately reflect the type. If
you're submitting a claim for "complex cataract surgery," be sure to
add additional diagnosis indicating why the case meets the criteria for
"complex." For example, the Medicare Administrative Contractor
Novitas' Local Coverage Determination (osmag.net/XSueD8) includes a
list of additional diagnoses that qualify as complex cases. This
includes the use of micro iris hooks inserted through 4 separate
corneal incisions, when a Beehler or similar expansion device is used,
C O D I N G & B I L L I N G
There are 70 options for cataracts in ICD-10,
so the surgeon's chart andreports must
accurately reflect the type.
