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Alicia: Q: For glaucoma bilateral dif types and dif stages, code each type but highest stage correct? Thanks, Carolyn
A: The fact is that there is a specific role for this. Now, let me just reiterate for some
people what glaucoma is because you kind of have to understand what it is to be able to
code it correctly. Glaucoma is that sight-threatening disorder. It's marked by an increased intraocular
pressure, or that's abbreviated IOP. And the pressure which is in the eye that is too high
for the optic nerve to tolerate. But to be more specific, I've got a little diagram of
what it does. But there are two types of glaucoma -- we'll there're several types of glaucoma
but there's two main types: open angle and closed angle. This is a closed angle view
and just to see the detail on this -- this was a really good shot and I want to show
it to you. The arrow is showing the pressure building up after the cornea.
If you go to the next page, because it shows you open and closed. You do want to note because
remember with diabetes, there's a default with type 2 diabetes because more people have
that. This doesn't have a default but it's good to note that open angle glaucoma accounts
for 90% of all cases because it's slow and it's a progressive disease. Whereas, close
angle is more of an acute situation; it happens very quickly and it's very painful. But most
people that have glaucoma, it's open angle.
What you're seeing there, the drainage in the open angle, see behind the cornea and
the iris, all that fluid that is there, that is all pressurized; and if the fluid flow
from the back of the eye or the inside of the eye and what is between the cornea and
the iris isn't kept at an even balance pressure builds up. But what happens with the pressure
is that, you think, "Well, OK, pressure," but remember that your eye is pressurized
and all the nerves and the blood vessels are so tiny in the eye that if you build up too
much pressure it squishes them.
Let's scroll down to the next page and they show...Here's an example of normal vision
and what people see when they start getting the glaucoma, see how it circles and starts
getting darker and darker, and you actually lose that peripheral sight. So, the progression
of glaucoma if you look at the optic nerve, see the optic nerve there, the red between
the yellow lines and it's nice and fat and juicy looking. Now, early damage though, if
you look, see those lines going top to bottom they're kind of straight; but in the second
early stage one there's that starts pressing on that optic nerve that the muscles start
bowing and there's a little circle or pocket of fluid that starts to build up and if you
could see it's actually inflamed. See the optic nerve starts getting inflamed. Then,
in the severe damage that's what you see when you look in but see how that optic nerve is
pushed out of proportion and there's a lot of pressure and fluid back there, once you
get into severe damage, there's nothing you can do, you lose your eyesight. So, this is
something you need to have checked, and lots of different things cause glaucoma, it's not
something I can put in the slide because it really would take so long.
Let's talk about the differences in coding for glaucoma: Bilateral low-tension glaucoma,
both moderate stages. Now, there's a difference between ICD-9 and ICD-10 so I wanted to bring
this out because I found this information on a fantastic blog. In ICD-9 you've got low
tension and moderate stage glaucoma. With glaucoma, you're going to usually have two
codes: the type of glaucoma and the stage. So, we've got bilateral, your choices are:
365.12 low tension glaucoma, 365.72 moderate stage glaucoma. Now, that means both eyes
(bilateral), that's what we're talking laterality here. ICD-10, though, one code, H40.1232 low-tension
glaucoma, bilateral, moderate stage. Unlike we talked before where it gives you more codes
for specificity, this is one code that covers everything.
Now, for example, let's say that the left eye has low-tension glaucoma, mild stage,
and the right eye has the same type but is moderate stage, ICD-9, how are we going to
code that? 365.12 low-tension glaucoma, 365.72 moderate-stage glaucoma. But, let's see what
we do with ICD-10, changes everything up, gives us laterality and granularity. Now we have H40.1221 low-tension
glaucoma, left eye, mild stage. Then, we have H40.1212 low-tension glaucoma, right eye,
moderate stage. See how much more specificity you get and there's no need for the payer
to say, "Well, we need some more information, and you're going to have to send in more documentation."
Now, the ICD-9-CM guidelines where it's still an ICD-9, so when you talk about the "guidelines
state for bilateral glaucoma when each eye is a different stage, assign one code for
the type and one for the highest glaucoma stage." So, now we're saying, you can't get
it very specific, you'll have one that's less. You're not able to tell the difference, and
you're not even able to tell if it's left or right. So, "Using ICD-9-CM for coding glaucoma
lacks essential details of the patient's condition. If we were looking for patient improvement
we wouldn't even know we were dealing with the involvement of both eyes and that only
one was mild stage. Of course, with ICD-10-CM laterality and 7th character extensions for
stages, there are many more code choices in the chapter. It makes sense in offering specific
data of the patient's condition and status. When data will be needed in the future for
pay-for-performance, other healthcare policies, or disease research, the numbers will be there
to be crunched." And one more thing to make note of here guys is that with ICD-9, the
reason that this question is even on the slide is because you don't know what to do. Now,
with ICD-10, you don't have to worry about it. See how specific it is? Less guess work
because it is very specific. Look, they got all the information from the right eye and
they got all the information for the left eye. No guessing about the guidelines, what
do I do; there's no confusion there, very specific and easy to code. You're going to
love ICD-10. This is when you throw in the whoop-whoop!