| Question |
Answer |
| Do we code staging for all glaucoma diagnoses? |
No, only for the following list of main glaucoma diagnoses:
365.10 Open-angle,unspecified
355.11 Primary OAG
365.12 Low-tension glaucoma, normal tension
365.13 Pigmentary glaucoma
365.20 Primary angle closure glaucoma, unspecified
365.23 Chronic or primary angle closure glaucoma
365.31 Steroid induced glaucoma
365.52 Pseudoexfoliation glaucoma
365.62 Glaucoma assoc w/ inflammation
365.63 Glaucoma assoc w/ vascular d/o
365.65 Glaucoma assoc w/ trauma |
| Do you know how often do we need to capture and report the new glaucoma staging codes per glaucoma patient (every visit, once a year, or until the stage changes)? |
These codes are more like systemic disease followed by ocular manifestation rules of ICD-9. These add-on codes are expected on each claim and yes, you would change them if the severity changes.
Keep in mind that in the future allocation for allowable payments are anticipated to be paid based on severity of disease. |
| New codes 365.70-365.74 don't seem to be as specific as the old codes. |
The new codes are in addition to the existing codes to identify the level of severity of disease based on the patients "worse" eye. |
| Are the new glaucoma severity codes (365.71, 365.72 etc.) mandatory when using 365.11, or do we have the choice to code 365.11 without one of the above as we've always done? |
At some point it may affect reimbursement.
Given the great variability in costs of care and resource utilization among glaucoma patients, glaucoma care will be targeted for the use of potential value-based modifiers in coming years. To prepare for this possibility, ICD-9/ICD-10 codes reflecting disease severity will allow for stratification of a patient population in a practice.
Consider two patients, both under the care of a single physician. Both patients have primary open-angle glaucoma. The first has minimal damage that requires one medication and follow-up visits twice a year; the second has advanced disease that requires multiple medications, numerous visits and surgery.
Under the old system, payers and researchers who used claims-based data were unable to distinguish between these two patients, as both would have been coded with 365.11. But with the new codes, their physician can accurately indicate each individual patient’s disease severity. |
| Are we still able to use 365.00 as glaucoma suspect? Do we need a severity code to go with that one? |
ICD-9 code 365.00 was not deleted and as a suspect there is not severity of disease. The entire 365.0X does not have the severity requirement.
However 365.00 is very non-specific and can mean open angle or narrow angle suspect.
Most patients should be coded more specifically.
Now there are two codes for open angle glaucoma suspect:
- 365.01 Low risk open angle suspect (1 to 2 risk factors)
- 365.05 High risk open angle suspect (3 or more risk factors)
And two codes for narrow angle suspect 365.02
- 365.02 Anatomical narrow angle, suspect
- 365.06 Primary angle closure (synechiae in angle or high IOP), no glaucoma damage
|
| Will these codes affect the PQRS reporting in any way? |
The qualifying denominators were selected with the Final Rule (2010). Whether the specifications will include these new codes for 2012 is yet to be determined. |
| If a patient had 365.63 in the left eye with a severity level severe, and in the right eye the patient had 365.11 with a severity level of mild, and both eyes and conditions were examined and treated that day, would the correct coding be 365.63-365.73-LT, 365.11-365.71-RT? |
Always report for the worse eye:
Step One: Code by Type
First code the type of glaucoma (only those listed below require the add-on staging codes):
Step Two: Add Stage
Second; determine the severity of the glaucoma in the worse eye, based on the new ICD-9 staging definitions. |
| Should the staging codes be added to glaucoma tests performed too? |
Yes. Payers have started adding the new staging codes to Local Coverage Determinations (LCDs).
Examples:
Wisconsin Physician Services (WPS)
Local Coverage Determination (LCD) for Optical Coherence Tomography (OCT) (L29971)
10/01/2011: ICD-9-CM 2012 coding update, 365.7 truncated, addition of 365.70, 365.71, 365.72, 365.73 and 365.74, addition of 379.27, effective 10/01/2011 (four).
First Coast Service Options (FCSO)
Local Coverage Determination (LCD) for Scanning Computerized Ophthalmic Diagnostic Imaging (L29473)
Start Date of Notice Period: 10/01/2011 Revised Effective Date:10/01/2011
Explanation of Revision: Annual 2012 ICD-9-CM Update.
Diagnosis range 365.00-365.04 (borderline glaucoma [glaucoma suspect]) revised to 365.00-365.06 to add new diagnosis codes 365.05 and 365.06 for procedure codes 92133 and 92134. Added diagnosis code 365.06 for procedure code 92132. The effective date of this revision is based on date of service.
National Government Services (NGS)
Local Coverage Determination (LCD) for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L28488)
R4 (effective 10/01/2011): LCD revised for annual ICD-9-CM code updates for 2012.
The “ICD-9-CM Codes That Support Medical Necessity” section of the policy was expanded with the addition of codes 365.05, 365.06, 365.70, 365.71, 365.72, 365.73, and 365.74 for CPT code 92133. Descriptor changed for 365.01. Several minor changes are made to reflect the current CMS and National Government Services current policy formats. No comment and notice periods required and none given.
National Heritage Insurance Company (NHIC)
Local Coverage Determination (LCD) for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L30266)
Revision History Explanation-R6: 10/01/2011
Technical correction: Due to the annual ICD-9-CM code update for 2012, ICD-9-CM codes 365.05, 365.06, 365.70, 365.71, 365.72, 365.73, 365.74, and 379.27 were added to the “ICD-9-CM Codes that Support Medical Necessity” section that correlates with CPT code 92133. |
