The Business of Contact Lenses

ICD-10 and Medically Necessary Contact Lens Prescribing

BY CLARKE D. NEWMAN, OD, FAAO

There is simply no way around it, we finally incorporated ICD-10-CM into clinical practice starting Oct. 1, 2015. So, as you receive this copy of Contact Lens Spectrum, you should be well underway in using ICD-10 codes in your practice. For those of you who have been hiding under a rock, the International Classification of Disease, or ICD, has offered 10 editions, and it will release the 11th edition in 2017. The United States is the last World Health Organization (WHO) member country on Earth to move to ICD-10 from ICD-9.

The 117 WHO member states, including the United States, voted to implement ICD-10-CM in 1990, and implementation began in 1994. It only took the United States 21 years to do what everyone else has already done. It is a little embarrassing.

Now it is October; if you have not even begun to implement ICD-10 into your practice, then you are in big trouble. The various payors all switched starting Oct. 1. ICD-10 is required of all providers under the Health Insurance Privacy and Portability Act, or HIPPA.

For a more comprehensive guide, The Centers for Medicare and Medicaid Services (CMS) has an entire web page devoted to this subject (www.cms.gov/Medicare/Coding/icd10).

Finalizing the Transition

I have a dog in this fight because ICD-10 will affect medically necessary contact lens prescribing. The good news is that the CMS Administrative Carriers will not deny claims for the first 12 months due to errors in specificity as long as the correct code “family” is used. That gives us a little wiggle room—for a time.

Make sure that your electronic health record (EHR) system is equipped to handle ICD-10 and that you have done the incorporating update.

After that comes the hard part. You have to educate your staff. The first part of educating your staff is educating yourself. You have to learn the new nomenclature.

The Big Picture

While this short article is not the forum for discussing ICD-10 in-depth, we can take a fly over to look at the major differences. In the ICD-9-CM, there were five character placements—three “category” placements and two “etiology, anatomic site, manifestation” placements; in Level I, they are all numeric. In the Level II codes, or the Healthcare Common Procedure Coding System (HCPCS) Codes, the first character is a letter.

In the new ICD-10-CM schema, there are seven character placements. The first is an alpha character, and the others are numeric. There are three “etiology” placements and an additional seventh character for “obstetrics, injuries, and external causes of injury.” In many of these codes, the last character in the second and third placements has been reserved by the placement of the letter “X.”

Most, but certainly not all, of the codes that we will use are in Chapter 6: Diseases of the Nervous System and in Chapter 7: Diseases of the Eye and Adnexa. The purpose of ICD-10-CM was to increase the specificity of diagnoses. For example, keratoconus has three codes in ICD-9 whereas in ICD-10, there are four, and they are more about which eye or eyes are involved.

If you haven’t already, purchase an ICD-10-CM code book. The American Optometric Association has an ICD-10-CM reference book available as well.

There is a lot to learn, but reading the code manual is a good time investment before you attend any classes. CLS

Dr. Newman has been in private practice in Dallas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine, and refractive surgery. He is a Diplomate in the AAO and a consultant to B+L, AMO, and Alden Optical. Contact him at cdnewman@earthlink.net.