Proposed new codes were introduced at the CMS Coordination and Maintenance Committee meeting.
The need for expanding the ICD-10-CM code choices for corneal dystrophy was a topic covered at the Centers for Medicare & Medicaid Services (CMS) ICD-10 Coordination and Maintenance Committee meeting in March when multiple new codes were proposed.
There are more than 20 types of corneal dystrophy. In the 2019 version of ICD-10-CM, there are only choices for nodular, other, unspecified, and hereditary, nullifying the coder’s ability to choose or drill down, as there are five layers in the cornea: the epithelium, the Bowman’s membrane, the stroma, the Descemet’s membrane, and the endothelium.
Clinically, corneal dystrophies can be divided into three groups, based on the anatomical location of the abnormality. Some affect primarily the corneal epithelium and its basement membrane, or Bowman layer, and others affect the superficial corneal stroma (or anterior corneal dystrophies), the corneal stroma (or Descemet membrane), and the corneal endothelium (or posterior corneal dystrophies). Many corneal dystrophies have no systemic manifestations. Macular corneal dystrophy and Schnyder corneal dystrophy do, though. Most corneal dystrophies affect both eyes and tend to run in families. They can appear at any age. Some are symptom-free and are found on routine eye exams.
Treatment depends on the type of dystrophy, as well as the severity of symptoms. Since the treatment depends on the type, types should be clearly available in the coding selections to take away the administrative burden of using a less specific choice and then fighting for coverage or benefits.
The American Academy of Ophthalmology requested new codes for hereditary, endothelial, granular, lattice, and macular dystrophies, and for complications due to transplant or transplant failure. These additions will help us better track outcomes and quality measurements. These selections also include laterality.
The proposal also pairs up with more offerings that are available in ICD-11. In ICD-11, there are choices for endothelial, dermochondrocorneal, dyslipoproteinaemic, choroidal, structural, congenital, tyrosinaemia type 2, and other dystrophies. “Other” encompasses granular, lattice, macular, stromal, and many other classifications. Interestingly enough, we actually lose some granularity in ICD-11 from the proposed breakdown in ICD-10-CM.
This is a good reminder that we have a long way to go in making clinical modifications that will be necessary for our use of the new coding classification in order for them to become most useful for our tracking and quality measures. I can’t imagine us embracing a coding system that actually takes us backward; instead, we will need to do the work required to make sure that our ICD-11 efforts are as robust as our ICD-10-CM efforts were, or it’s not worth making a transition.
There is also a chance to make sure our physician’s documentation is on point for the upcoming changes. We need to be forward-thinking in our planning. As a carpenter would say, “measure twice, cut once.” The same can apply to our documentation. If we turn to the many evidence-based guidelines for the various types of corneal dystrophy, we can then begin to document in a way that exceeds expectations in ICD-10 and also meets ICD-11 standards. As I have mentioned in past training and articles, the goals of good documentation should not be designed to meet coding requirements. Instead, focus your efforts on documenting for the appropriate condition through evidence-based medicine guidelines; you’ll more than meet any coding regulation or quality measure.
It’s frustrating to base our documentation on one code set and then try to bring it back or beef it up based on a new one. The patient’s clinical condition remains more or less the same, dependent on conditions being experienced. By focusing on this, you can take the administrative burden out of your documentation requirements.
Programming Note:
Listen to Rhonda Buckholtz report this story live today during Talk Ten Tuesday, 10-10:30 a.m. ET.
I recently mentioned that some facilities are receiving payer denials through which a reportable, clinically valid, documented diagnosis is removed from a claim because the
Today, I want to bring attention to an issue that is once again under scrutiny, how hospitals report patient harm events under the Centers for
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
