2017 ICD-10 Diagnosis Code Changes

The one-year ICD-10 grace period implemented by CMS will expire on September 30, 2016.  The grace period was implemented so that services would not be denied based solely on lack of specificity as long as a code from the appropriate family of codes was reported.  This included the use of unspecified codes.  Effective October 1, 2016, practices must begin reporting specific ICD-10 diagnosis codes to Medicare at the highest level of specificity.

The 2017 ICD-10 coding manual includes over 200 changes specific to ophthalmology involving the following code blocks:

  • Diabetic retinopathy (E10 and E11) now requires a 7th character to report laterality and includes several new codes specific to disease.
  • Central retinal vein occlusion (H34.8) now requires a 7th character to designate the severity of the occlusion.
  • Age-related macular degeneration (H35) includes laterality and diagnoses more specific to disease.
  • Glaucoma (H40) now includes laterality.
  • Glaucoma diseases classified elsewhere (H42) now includes an Excludes 2 note permitting glaucoma (in) diabetes mellitus (E08.39, E09.39, E10.39, E11.39, E13.39) to be reported separately.
  • Postprocedural hemorrhage (H59.3) includes several new and revised codes.

Providers should pay close attention to the new ICD-10 codes effective for dates of service on or after October 1, 2016 - September 30, 2017, to avoid medical necessity claim denials.