By: Teri Thurston, Billing & Coding Advisor, PECAA

Fall is here! Personally, this is one of my favorite seasons. Here in the Pacific Northwest the leaves are beginning to change and the weather is cooler. In my house we’re all settling into the new routines of being back in school. There are football games, cross country meets, lots of pumpkin spice lattes and the making of holiday plans as the year begins to wind down.

This time of year also brings a season of change in the optometric billing and coding world. The last quarter of each year is when CMS confirms the Final Rule, insurance payers introduce their new insurance plans and adjust existing plans. Medicare releases revised fee schedules and policy revisions. And, as with every October 1st since 2015, the new ICD-10-CM codes became effective for the 2018/2019 year. Medicare began accepting the new codes on October 1st, most other payers will begin accepting the new codes as of January 1, 2019.

The total number of code changes for this year equal 473, with 279 being new codes, 143 revised codes and 51 deactivated codes. Raising the total number of codes in ICD-10-CM code set to 71,932, for those of you keeping track. Specific to eye care this year however, there are 88 new code additions, 21 deletions and 9 revisions. These code changes add greater specificity to conditions of the eyelid and create coding solutions where there has been a deficit.

There are new codes and other changes in Chapter 2 Neoplasm – an example of the new codes to this chapter:

  • C43.111 Malignant melanoma of right upper eyelid, including canthus
  • C43.112 Malignant melanoma of right lower eyelid, including canthus
  • C43.121 Malignant melanoma of left upper eyelid, including canthus
  • C43.122 Malignant melanoma of left lower eyelid, including canthus

In Chapter 7, Diseases of the Eye and Adnexa, there are several new codes adding specificity to conditions of the eyelids, eliminating the need for multiple codes:

  • H01.00A Unspecified blepharitis right eye, upper and lower eyelids
  • H01.00B Unspecified blepharitis left eye, upper and lower eyelids
  • H01.01A Ulcerative blepharitis right eye, upper and lower eyelids
  • H01.01B Ulcerative blepharitis left eye, upper and lower eyelids
  • H01.02A Squamous blepharitis right eye, upper and lower eyelids
  • H01.02B Squamous blepharitis left eye, upper and lower eyelids

New Meibomian gland codes have been added! No longer will you need to be resourceful on what codes to use when billing for this condition.

  • H02.881 Meibomian gland dysfunction right upper eyelid
  • H02.882 Meibomian gland dysfunction right lower eyelid
  • H02.883 Meibomian gland dysfunction of right eye, unspecified eyelid
  • H02.884 Meibomian gland dysfunction left upper eyelid
  • H02.885 Meibomian gland dysfunction left lower eyelid
  • H02.886 Meibomian gland dysfunction of left eye, unspecified eyelid
  • H02.889 Meibomian gland dysfunction of unspecified eye, unspecified eyelid
  • H02.88A Meibomian gland dysfunction right eye, upper and lower eyelids
  • H02.88B Meibomian gland dysfunction left eye, upper and lower eyelids

New codes have been added to represent rosacea conjunctivitis and brow ptosis:

  • H10.821 Rosacea conjunctivitis, right eye
  • H10.822 Rosacea conjunctivitis, left eye
  • H10.823 Rosacea conjunctivitis, bilateral
  • H10.829 Rosacea conjunctivitis, unspecified eye
  • H57.811 Brow ptosis, right
  • H57.812 Brow ptosis, left
  • H57.813 Brow ptosis, bilateral

Terminology edits have been made to the Epiphora codes, the revised codes eliminate the reference to the lacrimal gland.

Revise from H04.221 Epiphora due to insufficient drainage, right lacrimal gland

Revise to H04.221 Epiphora due to insufficient drainage, right side

Download the Complete Coding Changes List & Other Helpful Guidelines

These are just a sampling of the coding changes becoming affective this fall. To be sent a complete list of the coding changes specific to eye care, fill out the form below.

You will also be sent all of the ICD-10-CM coding changes from the ICD-10-CM Tabular List of Diseases and Injuries 2019 Addenda, along with the complete coding guidelines in the ICD-10-CM Official Guidelines for Coding and Reporting for 2019.

Happy coding!

Want Assistance With Your Billing & Coding?

PECAA’s Billing & Coding Program helps eye care professionals learn to properly bill and code their practice’s medical and vision services with personalized consultation and exclusive customized education.

We would welcome the opportunity to speak with you directly to find out how we can help serve your needs. Please fill out an inquiry form here and a representative will be in touch with you soon. Or, simply e-mail Teri Thurston at or by calling 503.670.9200.

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