As certain as fall is upon us and Halloween is just around the corner, you can count on the World Health Organization (WHO) to release the new ICD-9 codes for the 2011-2012 year. WHO operates on an October 1 to September 30 year as opposed to a traditional calendar year. So all of the new, modified and deleted code changes that were made to the ICD-9 were effective as of October 1, 2011.

No, these aren’t the ICD-10 codes that you may have heard about, and are being implemented on October 1, 2013. Instead, these are changes to the ICD-9 codes that are currently in place.

A Brief Review of ICD-9
In 2000, the ICD-9-CM code sets were adopted for use in administrative transactions by both the public and private sectors to report diagnoses and inpatient hospital procedures under authority provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Covered entities required to use the ICD-9-CM code sets include health plans, health-care clearinghouses, and health-care providers who transmit any electronic health information in connection with a transaction for which HHS has adopted a standard.

Developed almost 30 years ago, the ICD-9 system is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains just 17,000 codes and is expected to start running out of available codes next year. The ICD-9 consists of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volumes 1 and 2; and the International Classification of Diseases, 9th Revision, Clinical Modification (CM), Volume 3, for diagnosis and procedure codes, respectively. We currently only use the diagnosis coding portion (Volume 3) of the ICD system for our practices.

What’s New?
Effective October 1, there are new classifications for the diagnosis of glaucoma. These changes were requested by the American Academy of Ophthalmology. The rationale that the WHO used to determine these changes is as follows: “Glaucoma is caused by damage to the optic nerve, and leads to vision loss. There are different types of glaucoma. Patients present for treatment at different stages of the disease. Typically, the earlier the patient presents for treatment, the better the outcome. It is important to identify the stages of glaucoma to monitor patient treatment and outcome.”

There are seven new codes and one revised code in this category:

  • 365.01 – Revised – Open angle with borderline findings, low risk.
  • 365.05 – New – Open angle with borderline findings, high risk.
  • 365.06 – New – Primary angle closure without glaucoma damage.
  • 365.70 – New – Glaucoma stage, unspecified.
  • 365.71 – New – Mild stage glaucoma.
  • 365.72 – New – Moderate stage glaucoma.
  • 365.73 – New – Severe stage glaucoma.
  • 365.74 – New – Indeterminate stage glaucoma.

Keep in mind that ICD-9 rules require that you must always code to the highest level of specificity––to the fifth digit, if possible––and that the only time you can use the patient’s symptoms as a diagnosis is in the absence of a confirmed diagnosis. In the simplest terms: General diagnoses are not allowed, and you are not allowed to use a “symptoms diagnosis” as the sole justification to perform additional tests when you already know the patient’s primary diagnosis.

Clinical Coding Committee
• John Rumpakis, O.D., M.B.A.,
  Clinical Coding Editor
• Joe DeLoach, O.D.
• David Mills, O.D., M.B.A.
• Laurie Sorrenson, O.D.
• Rebecca Wartman, O.D.

This is a very dynamic area that is changing rapidly. Even with the specter of the ICD-10s coming in 2013, each physician must demonstrate that he or she has software systems that will accommodate the ICD-10 codes on January 1, 2012.

Hold on tight––this wild ride is just beginning.

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