Stop Googling 2020 ICD-10 Codes for Ophthalmology—Try This Instead

by Ronda Tews, CPC, CHC, CCS-P | Oct 9, 2019 | ,

Here’s a Quick Reference Guide for ICD-10 Ophthalmology Codes, Plus an Easier, Faster Way to Find Codes in the Future

This post was originally published on October 15, 2018 and updated on October 9, 2019. 

There’s no way you can memorize all 72,000+ ICD-10 codes, so it seems easy enough to look the right one up on the Internet when you’re unsure. But the truth is, searching for ophthalmology ICD-10 codes manually can cost you valuable time and even add unnecessary risk, since search engines have no way to know what you’ve actually documented.

If you’re in need of some coding help right now or want to learn about the new ICD-10 codes for 2020 in ophthalmology, we’ve included a list of ICD-10 codes for ophthalmology for you to reference. But in the long run, there’s a better way to find codes than using lists or code lookups: using an ophthalmology EHR system that populates suggested codes automatically and provides helpful guidance based on your documentation.

Use the list below to navigate to the section of the post you’re most interested in.

  1. New ICD-10 Codes for 2020: Ophthalmology
  2. Ophthalmology Coding InfoSheet 2019: 50 Common Codes
  3. The Better Way to Find ICD-10 Codes for Ophthalmology
  4. Conclusion

To jump past the code lists and get straight to how the automated coding suggestions work, click here.

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New ICD-10 Codes for 2020: Ophthalmology

With the new ICD-10 updates that went into effect on October 1, 2019, we wanted to examine a few specific ICD-10 ophthalmology code changes from 2019 to 2020.

“Many of the 2020 ICD-10-CM updates are focused around additions related to orbital fractures. It’s all about increased specificity. Previously, there were no codes to specify the three walls of the orbit, but now with the 2020 ICD-10 code additions, there’s more clarity in documentation,” shared Dr. Michael Rivers, Director EMA® Ophthalmology.

Eye wall fractures

There are 60 new acute fracture codes for closed and open fractures of the orbital wall surrounding the eye, specific to laterality and position around the eye.

Example: New code S02.831B will report fracture of the medial orbital wall right side, initial encounter for open fracture.

2020 Eye Wall Fracture CodesDescription
S02.121AFracture of orbital roof, right side, initial encounter for closed fracture
S02.121BFracture of orbital roof, right side, initial encounter for open fracture
S02.121DFracture of orbital roof, right side, subsequent encounter for fracture with routine healing
S02.121GFracture of orbital roof, right side, subsequent encounter for fracture with delayed healing
S02.121KFracture of orbital roof, right side, subsequent encounter for fracture with nonunion
S02.121SFracture of orbital roof, right side, sequela
S02.122AFracture of orbital roof, left side, initial encounter for closed fracture
S02.122BFracture of orbital roof, left side, initial encounter for open fracture
S02.122DFracture of orbital roof, left side, subsequent encounter for fracture with routine healing
S02.122GFracture of orbital roof, left side, subsequent encounter for fracture with delayed healing
S02.122KFracture of orbital roof, left side, subsequent encounter for fracture with nonunion
S02.122SFracture of orbital roof, left side, sequela
S02.129AFracture of orbital roof, unspecified side, initial encounter for closed fracture
S02.129BFracture of orbital roof, unspecified side, initial encounter for open fracture
S02.129DFracture of orbital roof, unspecified side, subsequent encounter for fracture with routine healing
S02.129GFracture of orbital roof, unspecified side, subsequent encounter for fracture with delayed healing
S02.129KFracture of orbital roof, unspecified side, subsequent encounter for fracture with nonunion
S02.129SFracture of orbital roof, unspecified side, sequela
S02.831AFracture of medial orbital wall, right side, initial encounter for closed fracture
S02.831BFracture of medial orbital wall, right side, initial encounter for open fracture
S02.831DFracture of medial orbital wall, right side, subsequent encounter for fracture with routine healing
S02.831GFracture of medial orbital wall, right side, subsequent encounter for fracture with delayed healing
S02.831KFracture of medial orbital wall, right side, subsequent encounter for fracture with nonunion
S02.831SFracture of medial orbital wall, right side, sequela
S02.832AFracture of medial orbital wall, left side, initial encounter for closed fracture
S02.832BFracture of medial orbital wall, left side, initial encounter for open fracture
S02.832DFracture of medial orbital wall, left side, subsequent encounter for fracture with routine healing
S02.832GFracture of medial orbital wall, left side, subsequent encounter for fracture with delayed healing
S02.832KFracture of medial orbital wall, left side, subsequent encounter for fracture with nonunion
S02.832SFracture of medial orbital wall, left side, sequela
S02.839AFracture of medial orbital wall, unspecified side, initial encounter for closed fracture
S02.839BFracture of medial orbital wall, unspecified side, initial encounter for open fracture
S02.839DFracture of medial orbital wall, unspecified side, subsequent encounter for fracture with routine healing
S02.839GFracture of medial orbital wall, unspecified side, subsequent encounter for fracture with delayed healing
S02.839KFracture of medial orbital wall, unspecified side, subsequent encounter for fracture with nonunion
S02.839SFracture of medial orbital wall, unspecified side, sequela
S02.841AFracture of lateral orbital wall, right side, initial encounter for closed fracture
S02.841BFracture of lateral orbital wall, right side, initial encounter for open fracture
S02.841DFracture of lateral orbital wall, right side, subsequent encounter for fracture with routine healing
S02.841GFracture of lateral orbital wall, right side, subsequent encounter for fracture with delayed healing
S02.841KFracture of lateral orbital wall, right side, subsequent encounter for fracture with nonunion
S02.841SFracture of lateral orbital wall, right side, sequela
S02.842AFracture of lateral orbital wall, left side, initial encounter for closed fracture
S02.842BFracture of lateral orbital wall, left side, initial encounter for open fracture
S02.842DFracture of lateral orbital wall, left side, subsequent encounter for fracture with routine healing
S02.842GFracture of lateral orbital wall, left side, subsequent encounter for fracture with delayed healing
S02.842KFracture of lateral orbital wall, left side, subsequent encounter for fracture with nonunion
S02.842SFracture of lateral orbital wall, left side, sequela
S02.849AFracture of lateral orbital wall, unspecified side, initial encounter for closed fracture
S02.849BFracture of lateral orbital wall, unspecified side, initial encounter for open fracture
S02.849DFracture of lateral orbital wall, unspecified side, subsequent encounter for fracture with routine healing
S02.849GFracture of lateral orbital wall, unspecified side, subsequent encounter for fracture with delayed healing
S02.849KFracture of lateral orbital wall, unspecified side, subsequent encounter for fracture with nonunion
S02.849SFracture of lateral orbital wall, unspecified side, sequela
S02.85XAFracture of orbit, unspecified, initial encounter for closed fracture
S02.85XBFracture of orbit, unspecified, initial encounter for open fracture
S02.85XDFracture of orbit, unspecified, subsequent encounter for fracture with routine healing
S02.85XGFracture of orbit, unspecified, subsequent encounter for fracture with delayed healing
S02.85XKFracture of orbit, unspecified, subsequent encounter for fracture with nonunion
S02.85XSFracture of orbit, unspecified, sequela

New Z Codes

Z01.020 = Encounter for examination of eyes and vision following failed vision screening without abnormal findings.

Z01.021 = Encounter for examination of eyes and vision following failed vision screening with abnormal findings. Additional New ICD-10 Codes for 2020 Ophthalmology

Source: Centers for Medicare and Medicaid Service, CMS.gov 2020 ICD-10-CM listing

Ophthalmology Coding Info Sheet 2019: 50 Common Codes

Here’s a list of ICD-10 codes for ophthalmology in 2019, starting with some of the most commonly used:

CodeDescription
Z96.1Presence of intraocular lens
H25.13 Age-related nuclear cataract, bilateralAge-related nuclear cataract, bilateral
H04.123 Dry eye syndrome of bilateral lacrimal glandsDry eye syndrome of bilateral lacrimal glands
H52.4 PresbyopiaPresbyopia
H52.13 Myopia, bilateralMyopia, bilateral
H43.813 Vitreous degeneration, bilateralVitreous degeneration, bilateral
E11.9 Type 2 diabetes mellitus without complicationsType 2 diabetes mellitus without complications
H25.813 Combined forms of age-related cataract, bilateralCombined forms of age-related cataract, bilateral
H40.013 Open angle with borderline findings, low risk, bilateralOpen angle with borderline findings, low risk, bilateral
H35.3211 Exudative age-related macular degeneration, right eye, with active choroidal neovascularizationExudative age-related macular degeneration, right eye, with active choroidal neovascularization
H35.3221 Exudative age-related macular degeneration, left eye, with active choroidal neovascularizationExudative age-related macular degeneration, left eye, with active choroidal neovascularization
Z98.41 Cataract extraction status, right eyeCataract extraction status, right eye
Z98.42 Cataract extraction status, left eyeCataract extraction status, left eye
H40.1131 Primary open-angle glaucoma, bilateral, mild stagePrimary open-angle glaucoma, bilateral, mild stage
H52.03 Hypermetropia, bilateralHypermetropia, bilateral
Z98.890 Other specified postprocedural statesOther specified postprocedural states
H40.023 Open angle with borderline findings, high risk, bilateralOpen angle with borderline findings, high risk, bilateral
H52.223 Regular astigmatism, bilateralRegular astigmatism, bilateral
H35.373 Puckering of macula, bilateralPuckering of macula, bilateral
H43.811 Vitreous degeneration, right eyeVitreous degeneration, right eye
H40.1132 Primary open-angle glaucoma, bilateral, moderate stagePrimary open-angle glaucoma, bilateral, moderate stage
H35.3131 Nonexudative age-related macular degeneration, bilateral, early dry stageNonexudative age-related macular degeneration, bilateral, early dry stage
H43.812 Vitreous degeneration, left eyeVitreous degeneration, left eye
H35.372 Puckering of macula, left eyePuckering of macula, left eye
H35.371 Puckering of macula, right eyePuckering of macula, right eye
H43.393 Other vitreous opacities, bilateralOther vitreous opacities, bilateral
H35.363 Drusen (degenerative) of macula, bilateralDrusen (degenerative) of macula, bilateral
H02.834 Dermatochalasis of left upper eyelidDermatochalasis of left upper eyelid
H02.831 Dermatochalasis of right upper eyelidDermatochalasis of right upper eyelid
H35.033 Hypertensive retinopathy, bilateralHypertensive retinopathy, bilateral
H25.12 Age-related nuclear cataract, left eyeAge-related nuclear cataract, left eye
H25.11 Age-related nuclear cataract, right eyeAge-related nuclear cataract, right eye
H16.223 Keratoconjunctivitis sicca, not specified as Sjögren's, bilateralKeratoconjunctivitis sicca, not specified as Sjögren's, bilateral
H25.812 Combined forms of age-related cataract, left eyeCombined forms of age-related cataract, left eye
H10.45 Other chronic allergic conjunctivitisOther chronic allergic conjunctivitis
H35.3132 Nonexudative age-related macular degeneration, bilateral, intermediate dry stageNonexudative age-related macular degeneration, bilateral, intermediate dry stage
H40.053 Ocular hypertension, bilateralOcular hypertension, bilateral
H25.811 Combined forms of age-related cataract, right eyeCombined forms of age-related cataract, right eye
H26.493 Other secondary cataract, bilateralOther secondary cataract, bilateral
H52.203 Unspecified astigmatism, bilateralUnspecified astigmatism, bilateral
Z79.84 Long term (current) use of oral hypoglycemic drugsLong term (current) use of oral hypoglycemic drugs
H35.3122 Nonexudative age-related macular degeneration, left eye, intermediate dry stageNonexudative age-related macular degeneration, left eye, intermediate dry stage
Z01.00 Encounter for examination of eyes and vision without abnormal findingsEncounter for examination of eyes and vision without abnormal findings
E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateralType 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
H35.3112 Nonexudative age-related macular degeneration, right eye, intermediate dry stageNonexudative age-related macular degeneration, right eye, intermediate dry stage
H26.491 Other secondary cataract, right eyeOther secondary cataract, right eye
H26.492 Other secondary cataract, left eyeOther secondary cataract, left eye
H40.1133 Primary open-angle glaucoma, bilateral, severe stagePrimary open-angle glaucoma, bilateral, severe stage
H40.033 Anatomical narrow angle, bilateralAnatomical narrow angle, bilateral
Z79.899 Other long term (current) drug therapyOther long term (current) drug therapy

The Better Way to Find Ophthalmology ICD-10 Codes

Over time, the minutes you spend each time you need to scroll through lists of ICD-10 codes for ophthalmology can add up to hours that you could be spending with patients. And with all the data points involved in narrowing down specific codes and supporting your documentation, it can be easy to miss something if your coding process is manual or relies on codebooks, lookups or translation tools. This can sometimes lead to inaccurate coding and claim denials.

That’s why we built our ophthalmology EMR system, EMA, to make finding ICD-10 codes for ophthalmology easier. So easy, in fact, that you may not have to search for codes at all.

How does it work? Programmed by our on-staff practicing physicians, EMA contains a built-in list of ICD-10 codes for ophthalmology, as well as chief complaints, plans and procedures.

Using this comprehensive built-in knowledge, along with structured data technology, EMA is able to actually understand and leverage what you’re documenting for each patient. This allows EMA to automatically generate suggested ICD-10, E&M, CPT, modifier and codes in real time as you document, populating them on your ICD-10 ophthalmology superbill and encounter form for you to review and correct, as you determine is appropriate.

Although EMA takes the initial work out of searching for the correct code, its suggestions are a starting point, and you are always able to make changes before your final bill is submitted.  If you believe the visit warrants a different code than the one suggested by the system, you can override the suggested code at any time you wish. And when CMS releases its annual list of new ICD-10 codes for ophthalmology, EMA is updated accordingly. To save even more time, EMA actually remembers your most common diagnoses and treatments.

In addition to auto-generating suggested ophthalmology ICD-10 codes, EMA enables you to:

  • Automatically map diagnoses to a specific anatomical location by tapping on 3D eye diagrams in EMA’s Interactive Anatomical Atlas
  • Compare E&M codes to eye codes to help make sure they match
  • Benchmark your E&M and eye code utilization against other providers in your practice and against CMS Medicare Part B utilization data

EMA Makes it Easy to Capture the Data Points Needed for Ophthalmology ICD-10 Coding

EMA provides a variety of tools to help guide you to the right level of ICD-10 ophthalmology code specificity and meet documentation requirements.

When additional information is needed, the ICD-10 Expert box pops up to alert you. For instance, if you’ve diagnosed the patient with diabetic macular edema but only specified severity OD, it will prompt you to select severity OS and type of diabetes from a dropdown menu. Or if you’re documenting macular degeneration or primary open-angle glaucoma, it will prompt you to select staging if you haven’t already.

For some diagnoses, you’re required to enter an additional ICD-10 ophthalmology code to give context to how the original diagnosis occurred, or to give greater specificity for the cause of the condition or injury. In these cases, EMA will highlight the Associated Dx button, which you can tap on to easily select the appropriate associated diagnosis or cause code. EMA will also let you know which of those additional diagnoses require additional codes or must appear first according to the ICD-10 ophthalmology coding rules.

Diagnoses that may require this additional information include:

  • Primary open-angle glaucoma
  • Diabetic retinopathy
  • Blepharitis
  • Corneal foreign body
  • Age-related cataract
  • Diabetes
  • Trauma-induced cataract

If additional information isn’t available or you don’t feel it’s pertinent, you have the option not to add any.

For commercial insurances, if a code is missing required specifications, EMA will highlight it in yellow or red on the preliminary encounter form to alert you that this claim is at risk for denial. This can be a helpful reminder to go back and add specifics such as location and stage if you missed them earlier.

Conclusion

It’s easy to see how EMA’s powerful ophthalmology ICD-10 coding assistance functionality can help make your workflow smoother and ease your mind when it comes to the risk of claim denials. Not only is it faster than using search engines and scrolling through lists, but also it provides powerful tools to help you code more mindfully and stay in line with ICD-10 ophthalmology coding rules.

Is it worth considering an ophthalmology EMR system switch just to simplify your coding process? If you ask many ophthalmologists who have made the switch to EMA, the answer is a resounding yes.

But if you’re not completely sure, take a moment to consider the other facets of your ophthalmology EHR. Is it easy to use and ophthalmology specific? Does it simplify MIPS participation and support interoperability with other systems? Is it reasonably priced? Do you get outstanding support from an award-winning team?

You may find that inefficient ICD-10 coding is just one of many signs it’s time to switch your ophthalmology software. The good news is, switching can be a lot easier than you think.

So if you’re curious to see all the ways EMA can help you chart and code faster while delivering your best care, get in touch with our team today—we’d love to get you started.

Source

Centers for Medicare and Medicaid Services. 2019 ICD-10-CM. https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html. Published June 20, 2019. Accessed October 9, 2019.

Ronda Tews, CPC, CHC, CCS-P

Ronda Tews, CPC, CHC, CCS-P

DIRECTOR OF BILLING AND CODING COMPLIANCE

Ronda Tews, Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC), and Certified Coding Specialist-Physician (CCS-P), is the director of billing and coding compliance at Modernizing Medicine® and brings over two decades of robust healthcare compliance experience to the organization. In her current role, she develops and manages the billing and coding compliance program for the company. Ronda performs billing and coding compliance audits among other related functions while maintaining knowledge of current regulatory and compliance guidance.

Prior to her time at Modernizing Medicine, Ronda held various roles such as managing provider compliance for a large health plan in Oklahoma and creating a fraud, waste and abuse program. Ronda’s duties have consisted of conducting E/M audits on physicians and mid-level providers, establishing internal auditing and monitoring, as well as teaching basic coding classes to co-workers and providing E/M documentation training to physicians and mid-level providers. She has also implemented compliance education and training programs, managed the Compliance Report Line as well as compliance auditing and monitoring. Ronda also provided coding and documentation education at Missouri State University to the physician assistant students on an annual basis. Ronda has held various roles such as serving as a Quality Improvement analyst and working as a corporate compliance project manager for a large Mid-Western health system.

Ronda founded the Springfield, MO AAPC chapter where she served as the president and treasurer. She remains very active in the industry as she writes articles for industry publications and can be found speaking at conferences. Connect with Ronda on LinkedIn.

2019: Ophthalmology ICD-10 Codes

A Quick Reference Guide for ICD-10 Updates

*Please note, the information below relates to 2019 ICD-10 coding updates. 

With the new ICD-10 updates that went into effect on October 1, 2018, we wanted to examine a few specific ophthalmology code changes from 2018 to 2019.

“The 2019 ICD-10-CM updates primarily affect oculoplastic specialists. The improved documentation of diseases of the lids and face are much more specific. For example, treating a patient with Paralytic Lagophthalmos can be documented more specifically,” shared Dr. Michael Rivers, Director EMA™ Ophthalmology.

Lagophthalmos

To break down the changes on eyelid specific diagnoses, let’s look at “Paralytic Lagophthalmos.” For 2019, there are three new, additional Lagophthalmos codes used to specify when a patient has the same disease on multiple eyelids.  

Example: Paralytic Lagophthalmos (H02.23)

2018 ICD-10 “Paralytic Lagophthalmos (H02.23)”
4 location specific diagnoses
2019 ICD-10 “Paralytic Lagophthalmos (H02.23)”
7 location specific diagnoses
H02.231 - Right upper eyelidH02.231 - Right upper eyelid
H02.232 - Right lower eyelidH02.232 - Right lower eyelid
H02.234 - Left upper eyelidH02.234 - Left upper eyelid
H02.235 - Left lower eyelidH02.235 - Left lower eyelid
H02.23A - Right eye, upper and lower eyelids
H02.23B - Left eye, upper and lower eyelids
H02.23C - Bilateral, upper and lower eyelids

Blepharitis and Meibomian Gland Dysfunction

Blepharitis and Meibomian Gland Dysfunction diagnoses also have new ICD-10 codes to specify diseases affecting multiple eyelids. Unlike Lagophthalmos, these new eyelid combination codes do not have a code for bilateral eyes with upper and lower eyelids. It only has codes for “right eye, upper and lower lids” and “left eye, upper and lower lids.”

Example: H01.00 Unspecified blepharitis

2018 ICD-10 “H01.00 Unspecified blepharitis”
4 location specific diagnoses
2018 ICD-10 “H01.00 Unspecified blepharitis”
6 location specific diagnoses
H01.001 - Right upper eyelidH01.001 - Right upper eyelid
H01.002 - Right lower eyelidH01.002 - Right lower eyelid
H01.004 - Left upper eyelidH01.004 - Left upper eyelid
H01.005 - Left lower eyelidH01.005 - Left lower eyelid
H01.00A - Right eye, upper and lower eyelids
H01.00B - Left eye, upper and lower eyelids

Additional New 2019 Ophthalmology ICD-10 Codes

“Rosacea Conjunctivitis,” “Brow ptosis” and “Other specified disorders of eye and adnexa” are completely new diagnoses in 2019 ICD-10. They are listed below.

Paralytic ectropion of eyelid
H02.154 Paralytic ectropion of left upper eyelid
H02.155 Paralytic ectropion of left lower eyelid
H02.151 Paralytic ectropion of right upper eyelid
H02.152 Paralytic ectropion of right lower eyelid
Rosacea Conjunctivitis
Code first underlying rosacea dermatitis (L71.-)
H10.821 - Rosacea conjunctivitis, right eye
H10.822 - Rosacea conjunctivitis, left eye
H10.823 - Rosacea conjunctivitis, bilateral
H10.829 - Rosacea conjunctivitis, unspecified eye
Brow Ptosis
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

Want more on ICD-10? Visit our “2019 ICD-10 Changes” blog post for additional medical specialties updates and learn how our ophthalmology EHR, EMA, can help your practice.

Source

Centers for Medicare and Medicaid Services. 2019 ICD-10-CM. https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html. Published September 18, 2018. Accessed September 26, 2018.

Danielle Zarnowiec, MBA

Danielle Zarnowiec, MBA

Requirements Analyst

Danielle Zarnowiec joined Modernizing Medicine in October 2012 and in her current role she serves as the team lead for EMA’s Medical Coding Engine and RCM’s Intelligent Claims Engine.

Previously, Danielle was the owner and operator of a Revenue Cycle Management (RCM) company specializing in medical coding consulting, revenue cycle management and physician quality reporting.

Danielle earned a bachelor’s degree in business administration from St. Andrews University where she served as captain of the NCAA women’s soccer and tennis teams. She then graduated from Palm Beach Atlantic University with an MBA in international business.

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