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2011
ICD9 Changes
Kathleen Santa Maria
The following
changes to ICD9 take effect October 1, 2011.
The complete list of changes is available at
http://www.cms.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage
New codes to
quantify glaucoma into mild, moderate and severe disease based on the
visual field were created. The
type of glaucoma is coded first. The
type codes require an add-on of a staging code.
Glaucoma codes
that require the add-on code to identify severity
365.10
Open-angle glaucoma
365.11
Primary open-angle glaucoma
365.12
Low-tension glaucoma or normal tension glaucoma
365.13
Pigmentary Glaucoma
365.20
Primary angle-closure glaucoma, unspecified
365.23
Chronic or primary angle-closure glaucoma
365.31
Steroid-induced glaucoma
365.52
Pseudoexfoliation glaucoma
365.62
Glaucoma associated with ocular inflammations
365.63
Glaucoma associated with vascular disorders
365.65
Glaucoma associated with ocular trauma
Add-on Code
365.71
Mild or early-stage glaucoma
365.72
Moderate-stage glaucoma
365.73
Severe-stage glaucoma
365.74
Indeterminate (visual field not performed or uninterpretable)
365.79
Unspecified, stage not recorded
Severity is
determined by the physician based on visual field findings.
Instructions for quantifying the visual field are included in ICD9.
365.01
description is changed to Open angle with borderline findings, low risk
New codes for
Malignant lesions of the eyelids and face
173.10
Unspecified malignant neoplasm of eyelid, including canthus
173.11
Basal cell carcinoma of eyelid, including canthus
173.12
Squamous cell carcinoma of eyelid, including canthus
173.19
Other specified malignant neoplasm of eyelid, including canthus
173.30
Unspecified malignant neoplasm of skin of other and unspecified
parts of the face
173.31
Basal cell carcinoma of skin of other unspecified parts of face
173.32
Squamous cell carcinoma of skin of other unspecified parts of face
173.39
Other specified malignant neoplasm of skin of other and unspecified
parts of face
173.80
Unspecified malignant neoplasm of other specified sites of skin
173.81
Unspecified malignant neoplasm of other specified sites of skin
173.82
Basal cell carcinoma of other specified sites of skin
173.89
Other specified malignant neoplasm of other specified sites of skin
Other
New Codes
379.27
Vitreomacular adhesion
V19.11
Family history of glaucoma
V19.19
Family history of other specified eye disorder
The
following codes are invalid effective October 1, 2011
173.1
Other malignant neoplasm of skin of eyelid including canthu
173.3
Other malignant neoplasm of skin of other and unspecified parts of
face
173.8
Other malignant neoplasm of other specified sites of sking
173.9
Other malignant neoplasm of skin, site unspecified
V19.1
Family history of other eye disorders
Improving Your OCT Technique
Julia Monsonego
If you are having a difficult time obtaining a clear image while performing an OCT, try this....
1. Check the lens for smudges or tears.
2. Give the patient of drop of refresh. A dry cornea can cause lower signal strength.
3. Check the patient’s positioning. Make sure their chin is in the cup and forehead completely forward and straight.
4. Find the "sweet spot." If the patient has a cataract, focus anteriorly on the cataract first before focusing on the retina and find an area where you can make your way around it. Most of the time there is an area where it is less dense, usually superiorly where there will be a clearer view.
5. Check your focus. If the retinal vessels are not in focus, the signal strength will be lower. Even a few diopters can make a big difference.
6. Patch the fellow eye if the patient is having trouble fixating or having double vision,. This method could also work if the patient's dilation is starting to wear off. It can help to open the pupil up a small amount which may just be enough to obtain a better scan.
7.Position nystagmus patients so the acquisition occurs at its edge. The patient normally holds their eye still for a moment longer at this point and you will have a better opportunity in getting a more reliable scan here than in the center.
8. If using the Zeiss Cirrus OCT and you are finding that not all of your scans are centered in the acquisition box and some are being cut off, try moving your scan off center in the pupil by clicking directly on the pupil on the screen. Click around until the scans straighten out. Depending on the shape of the patient's eye, an off centered pupil may give you an on center scan. However, in patients with high myopia it may be impossible to avoid cut off. In this case, concentrate on your horizontal and vertical scans through the optic nerve and allow for cut off in the periphery (lower boxes)
9. Every office has an OCT protocol, but if the patient is next to impossible to scan, and we all have them-
Start with the scan that will give the most valuable information to the physician. Whether it be due to patient cooperation, whether they're 99 or 3, or caused by their diagnosis, the best scans you will be able to obtain with difficult patients will usually be the first scans. So if it is a neuro or glaucoma patient, start with the RNFL scan. A retina patient, start with a line scan straight through the fovea. Even if you are unable to get a macular thickness map, a lot of OCT's can give thickness calculations from a single line scan. Then try to get the rest of your scans. But if you can't, at least you were able to get the scans that mattered most.
10. Above all, give your patients clear instructions. Communicate with them throughout the test. Tell them when they can blink freely, when they are doing a good job. If they are tired give them a break between testing each eye. Use the time to print while they take a moment to rest. Many times the patient gets to us at the end of a long day and they are tired, hungry, and possibly frustrated. Ask for assistance when you need it and remember to take a break yourself!
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