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.


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