Gear Up for 2019 ICD-10-CM Code Changes – Part 4

Posted on 4 Oct, 2018 |comments_icon 0|By Elizabeth
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Get acquainted with 100+ new and revised ICD-10 codes for ophthalmology.

Of all the specialties, ophthalmology practices have been hit the hardest in terms of diagnostic code changes. The grand total comes in at just over 100 updates, so we’ve got a lot of ground to cover!

In addition to new neoplasm codes, you’ll have several more options for disorders of the eyelid, lacrimal system, and orbit — including paralytic ectropion, cicatricial lagophthalmos, rosacea conjunctivitis, meibomian gland dysfunction, and others. As with most code changes this year, CMS is aiming at greater specificity.

H01.00 Unspecified blepharitis
  • H01.00A — Unspecified blepharitis right eye, upper and lower eyelids
  • H01.00B — Unspecified blepharitis left eye, upper and lower eyelids
H01.01 Ulcerative blepharitis
  • H01.01A — Ulcerative blepharitis right eye, upper and lower eyelids
  • H01.01B — Ulcerative blepharitis left eye, upper and lower eyelids
H01.02 Squamous blepharitis
  • H01.02A — Squamous blepharitis right eye, upper and lower eyelids
  • H01.02B — Squamous blepharitis left eye, upper and lower eyelids

For H02 (Other disorders of eyelid), there’s a new subcategory, H02.1 (Ectropion of eyelid) that includes the following new codes:

  • 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
New Lagophthalmos Codes

You’ll also find many new lagophthalmos (H02.2) code options that address specificity through location and laterality.

H02.20 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
H02.21 Cicatricial lagophthalmos
  • H02.21A — Cicatricial lagophthalmos right eye, upper and lower eyelids
  • H02.21B — Cicatricial lagophthalmos left eye, upper and lower eyelids
  • H02.21C — Cicatricial lagophthalmos, bilateral, upper and lower eyelids
H02.22 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
H02.23 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
Meibomian Gland Dysfunction Category

More specific code options have been added to other specified disorders of eyelid (H02.8) via a new subcategory for Meibomian gland dysfunction (H02.88).

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
  • H02.889 — Meibomian gland dysfunction of unspecified 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

Also note revisions to code descriptors in the H04.2 Epiphora family, as well as new codes for conjunctivitis (H10.8) and disorders of eye and adnexa (H55-H57). These new code additions include:

H10.82 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

[And]

H57.8 Other specified disorders of eye and adnexa
  • H57.81 — Brow ptosis
  • H57.811 — Brow ptosis, right
  • H57.812 — Brow ptosis, left
  • H57.813 — Brow ptosis, bilateral
  • H57.819 — Brow ptosis, unspecified

H57.89 — Other specified disorders of eye and adnexa

Melanoma and Other Malignant Neoplasms of the Eyelid

For melanoma and other malignant neoplasms of skin, note the following changes:

  • Multiple sixth and seventh character extensions to specify upper or lower eye lid (C43.1, C44.1 & C4A.1). For example:
  • C43.111 — Malignant melanoma of right upper eyelid, including canthus
  • C43.112 — Malignant melanoma of right lower eyelid, including canthus
  • C43.121 — Malignant melanoma of left upper eyelid, including canthus
  • C43.122 — Malignant melanoma of left lower eyelid, including canthus
  • C4A.111 — Merkel cell carcinoma of right upper eyelid, inc canthus
  • C4A.112 — Merkel cell carcinoma of right lower eyelid, inc canthus
  • C4A.121 — Merkel cell carcinoma of left upper eyelid, inc canthus
  • C4A.122 — Merkel cell carcinoma of left lower eyelid, inc canthus
  • C44.1021 — Unspecified malig neoplasm skin/ right upper eyelid, inc canthus
  • C44.1022 — Unspecified malig neoplasm skin/ right lower eyelid, inc canthus
  • C44.1091 — Unspecified malignant neoplasm skin/ left upper eyelid, inc canthus
  • C44.1092 — Unspecified malignant neoplasm skin/ left lower eyelid, inc canthus
  • One new subcategory (C44.13 – Sebaceous cell carcinoma of skin of eyelid, including canthus) includes a six-character for left or right eyelid and seventh character extensions for upper or lower eye lid.
  • With the addition of the new codes and seventh character extensions, 12 codes are now invalid.

For the in-situ neoplasms (D00-D09), you’ll have multiple seventh character extensions to specify upper or lower eye lid (D03.1 and D04.1).

Again, for benign neoplasms, except benign neuroendocrine tumors (D10-D36), you’ll have multiple seventh character extensions to specify upper or lower eye lid (D22.1 and D23.1).

For example, if a patient has a squamous cell carcinoma of the right lower eyelid, including canthus, report C44.1222 (Squamous cell carcinoma of skin of right lower eyelid, including canthus).

Deletions: Four codes are now invalid, including D23.11 for other benign neoplasm of skin of right eyelid.

Learn More

Did you catch our earlier posts in this series?

  • ICD-10-CM Code Changes Part 1 unravels key code changes for cardiology and emergency medicine.
  • In Part 2 , we lay out new diagnostic codes impacting gastroenterology, general surgery, internal medicine, and primary care.
  • Part 3 continues our specialty-by-specialty breakdown of ICD-10 code changes for 2019 with a front-row seat on updates affecting ob-gyn and pediatric practices.

Equip your team with the industry’s top ICD-10-CM coding resources!

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Also, to receive practical ICD-10 training strategies, answers to your ICD-10 coding questions, specific examples to help you apply ICD-10 coding fundamentals, check out ICD-10 Coding Alert.

Author

Elizabeth


Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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