Ask the Codeheads: All ODs need to know about the ICD-10 coding changes (for now)

December 3, 2012

Edited by Chuck Brownlow, O.D., Medical Records consultant, AOAExcel

The implementation of ICD-10 has been delayed until Oct. 1, 2014. ICD-9 will be in full force for all services one provides through Sept. 30, 2014. Between now and then, the AOA will provide a lot of information and advice about how to prepare, but most of that will be delayed until much closer to the implementation date.

For now, it will be important to watch AOA News and other professional media for general information about ICD-10, including suggestions regarding how it might impact your practice.

In general, though there will be many more codes in ICD-10 than in ICD-9, and individual codes will include more key information about each case. That means fewer codes will be needed to reflect the diagnosis and details related to the management of each patient’s case.

For example, for ICD-9 reporting residual stage open-angle glaucoma, moderate stage, one would report 365.15, plus a second code indicating the stage, 365.72. In ICD-10, a single code will include all that information, H40.1532.

I found this code by going to a free website, http://www.icd10data.com, and entering primary open-angle glaucoma, moderate stage. The answer popped up immediately.

The fear of ICD-10 should quickly dissipate when one spends a little time with online research, realizing that all these resources will become even more accurate and user-friendly as the ICD-10 implementation date approaches.

Although there will be more codes to work with in ICD-10, making it difficult to work purely from standard, hard copy reference manuals, computer software will offer greater ease and accuracy than has been available before. Better yet, much of that software will be incorporated into office management and electronic health record software or available as standalone software, free or at very low cost.

With this in mind, it will be important to resist spending a lot of money on staff and physician education regarding ICD-10, certainly through 2013.

Many vendors are already aggressively promoting their education materials, often employing fear tactics to convince you to “sign up.”

Just as with HIPAA education 10 years ago, you can be pretty sure that adapting to ICD-10 will not be as bad as it sounds and certainly won’t be as expensive as some would have you believe.

For now, until a few months before Oct. 1, 2014, it is important that you pay very close attention to the correct application of the current coding resources, ICD-9 and Current Procedural Terminology (CPT © American Medical Association, AMA).

When you purchase references for 2013, be sure to get the official AMA CPT.

Many other publishers offer books that “interpret” or “simplify” CPT, which often leads to disagreements and misunderstandings with the accurate choices of codes.

ICD-9 and CPT help you understand the rules of medical record-keeping and coding and provide you with all the diagnosis and procedure codes you’ll need for submitting accurate claims to Medicare and other insurers.

You may want to supplement CPT with the Documentation Guidelines for the Evaluation and Management Services (99000 series office visit codes), which provide a very objective and repeatable means of accurately matching the content of your patient’s record to the proper office visit code.

The AMA CPT and ICD-9, abridged for eye care, are available through the AOA Order Department as a package titled “Codes for Optometry.” Call 800-262-2210 to order.


  1. Do you have any guidance for ICD 9 codes for visual processing disorders and for use with the 97000 CPT codes?

    • All carriers are different and the options are in the hundreds.

      If you visit the free AOA Member Benefit site of aoacodingtoday it is a valuable resource for times like these.

      Once logged in, enter the CPT code that you want.

      Next, you need to click on the ICD-9 Link on the left side of the screen. It will provide a full list of MEDICARE approved ICD-9 linked to the code. Again, this is limited to Medicare. For instance, some BCBS cover more binocular vision diagnosis codes, but less low vision.

      Hopefully this helps.

      Dr. Harvey Richman, FAAO, FCOVD

      Diplomate American Board of Optometry


      136 Main Street

      Manasquan, NJ 08736




      AOA Third Party Center Executive Committee

      Past President, New Jersey Society of Optometric Physicians

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