Ophthalmology and Optometry Coding Alert

Example: Your ophthalmologist is evaluating a patient with blurry and double vision following a traffic accident. The patient states that his injuries resulted from a collision with a pedestrian while driving an e-bicycle earlier that day. You can now kick the specificity up a notch and use V20.41X- (Electric (assisted) bicycle driver injured in collision with pedestrian or animal in traffic accident …) to report the crash.

Coding tip: When adding an external cause code to your claim, don’t forget to use the appropriate 7th character — A (… initial encounter), D (… subsequent encounter), or S (… sequela) — to indicate the type of encounter.

Examine Extended Med Use Code Expansion

You’ll find a bunch of new Z codes for “long-term (current) use of” a variety of therapies. Going forward, you can account for immunotherapy, chemotherapeutic agent, and injectable antidiabetic drug use with the following:

• Z79.6- (Long term (current) use of immunomodulators and immunosuppressants)

o Z79.60 (Long term (current) use of unspecified immunomodulators and immunosuppressants)

o Z79.61 (Long term (current) use of immunomodulator)

o Five six-character codes categorized under Z79.62- (Long term (current) use of immunosuppressant)

o Five six-character codes categorized under Z79.63- (Long term (current) use of chemotherapeutic agent)

o Z79.64 (Long term (current) use of myelosuppressive agent)

o Z79.69 (Long term (current) use of other immunomodulators and immunosuppressants)

• Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs)

These codes will allow you to show insurers more information about medical conditions that may stem from extended use of these medications.

Example: A patient with diabetes and retinopathy presents for evaluation at the recommendation of her endocrinologist. She reports a rapid improvement in glucose control after starting Trulicity, a weekly injectable non-insulin antidiabetic mediation. Because this drug has been associated with a temporary worsening of diabetic retinopathy, patients with a history of diabetic retinopathy should be monitored for disease progression.

Coding for this encounter would include the appropriate ICD-10 code to describe the level of retinopathy, as well as Z79.85 for the Trulicity, says Mary Pat Johnson, CPC, CPMA, COMT, COE, senior consultant with Corcoran Consulting Group.

Do this: Check out the updated ICD-10-CM guidelines, as there are some new Excludes2 notes sprinkled throughout category Z79 to which coders should pay attention.

“Adding a diagnosis from this expanded category provides a better electronic explanation of these tests or treatments,” explains Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist, University of Pennsylvania Department of Medicine. “When patients present for infusion services or require laboratory testing to ensure drug efficacy and safety, the claim reporting is better serviced with the addition of a specific Z79 code that identifies the therapy the patient is receiving,” she adds.

Comply With These Novel Noncompliance Codes

When patients are unable or unwilling to follow medical treatment, it’s important to note that fact in their medical records, and in some cases, you also need to share that information with insurers. A crop of new ICD-10 codes can help you do that. Now you can choose from the following to report a patient’s failure to adhere to the doctor’s orders:

• Z91.110 (Patient’s noncompliance with dietary regimen due to financial hardship)
• Z91.118 (… for other reason)
• Z91.119 (… due to unspecified reason)
• Z91.190 (Patient’s noncompliance with other medical treatment and regimen due to financial hardship)
• Z91.198 (… for other reason)
• Z91.199 (… due to unspecified reason)

The 2023 edition of ICD-10-CM further boosts your options with the addition of “a new category of codes that allow for the assignment of caregiver noncompliance and reasons for such noncompliance,” which you could only document previously with a code for “other noncompliance,” according to Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, senior consultant at Pinnacle Enterprise Risk Consulting Services LLC, in Centennial, Colorado.

Under this new category, Z91.A- (Caregiver’s noncompliance with patient’s medical treatment and regimen), you’ll find several analogous codes to the patient noncompliance codes, including Z91.A10 (Caregiver’s noncompliance with patient’s dietary regimen due to financial hardship) and Z91.A9 (Caregiver’s noncompliance with patient’s other medical treatment and regimen).

However, Z91.A- also adds codes that provide greater specificity for caregiver noncompliance such as:

• Z91.A20 (Caregiver’s intentional underdosing of patient’s medication regimen due to financial hardship)
• Z91.A28 (Caregiver’s intentional underdosing of medication regimen for other reason)
• Z91.A3 (Caregiver’s unintentional underdosing of patient’s medication regimen)
• Z91.A4 (Caregiver’s other noncompliance with patient’s medication regimen)
• Z91.A5 (Caregiver’s noncompliance with patient’s renal dialysis)

Example: A patient with dementia and glaucoma presents to the office with his caregiver for follow-up. Testing reveals an increase in intraocular pressure. When the doctor asks whether they are using the latanoprost drops every evening, his wife admits that she occasionally forgets to give him the medication. She states that she applies the drops three to four times a week. The new Z codes enable you to report situations like this with greater specificity using Z91.A3 (Caregiver’s unintentional underdosing …).

Glance at Updated Underdosing Guidance

ICD-10-CM 2023 also revamps guideline I.C.19.e.5.(c), which will affect the way you assign both new codes Z91.A28 and Z91.A3 along with the numerous other underdosing codes currently found throughout ICD-10.

The new wording states that “documentation of a change in the patient’s condition is not required in order to assign an underdosing code. Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”

The medical record simply needs to show the patient is not taking the prescribed dose of a medication, not that underdosing is adversely affecting the patient’s condition. Under such circumstances, go ahead and code T36-T50 for the underdosing, along with the appropriate noncompliance (Z91.12-, Z91.13-, Z91.14-) or complication of care (Y63.6- Y63.9) code(s) according to the current guideline.

Remember: You should not assign an underdosing code as a principal code “if a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose.” In such cases, the existing guideline instructs you to code the patient’s medical condition as the first-listed code.