Questions/Answers for ICD-10-CM Coding: Chapter 7 and Chapter 8 Diseases of the Eye/Adnexa and Ear/Mastoid Process

1.   True or False: When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage?

Correct answer: True

2.    The patient has a significant visual impairment (category 2) due to astigmatism in the left eye. It is corrected with glasses. The right eye has normal vision. What ICD-10-CM coding is reported?

Correct answer: H52.202, H54.52A2

3.    A patient is admitted to the hospital for surgery to correct bilateral chronic and acute serous otitis media with insertion of tympanostomy tubes. What ICD-10-CM codes are reported?

Correct answers: H65.03, H65.23

4.    A patient presents to the ED with dizziness, nausea, and vomiting. She is admitted for further workup. In the Discharge Summary, the provider documents possible Meniere’s disease. What ICD-10-CM code(s) are reported?

Correct answer: H81.03

5.    While in the hospital, a patient sees an ophthalmologist to examine an old injury with a retained magnetic iron metal foreign body in his posterior wall in the right eye. What are the ICD-10-CM Code(s) assgined.

Correct answers: Z18.11, H44.641

Chapter 7 and Chapter 8 Answer Rationales

Question 1 Rationale

Rationale: Per ICD-10-CM guideline I.C.7.a.2, When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.

Question 2 Rationale

Rationale:

ICD-10-CM Alphabetic Index Impaired, impairment (function) > Vision NEC > H54.7.

In the Tabular List, category H54 has a note to see the definition of visual impairment categories. Category 2 is considered low vision.

Looking through the codes, low vision in the left eye is reported with H54.52-. A2 is assigned as 6th and 7th characters to identify Category 2.

Or, you can look in the Alphabetic Index for Low>vision>one eye>left (normal vision on right), referring you to H54.52.

It is important to read the instructional notes in the Tabular List that are associated with categories before selecting your code.

Category H54 also has a note to code first any cause of the blindness.

In this case, the low vision is due to the astigmatism.

Alphabetic Index: Astigmatism> H52.20-. In the Tabular List, H52.202 is reported for the left eye.     

Question 3 Rationale

ICD-10-CM Alphabetic Index: Otitis > Media > Serous > “See” Otitis media, nonsuppurative. Otitis > Media > Nonsuppurative > Acute > Serous > H65.0-.

ICD-10-CM Alphabetic Index: Otitis > Media > Nonsuppurative > Chronic > Serous > H65.2-.  

The hyphen after both codes indicates you will need additional character(s). In the Tabular List a 5th character 3 is selected for both codes to indicate the condition is bilateral.

Per ICD-10-CM guideline I.B.8, when a condition is diagnosed as acute and chronic and there are different codes for each, report both codes, sequencing the acute code first.

Question 4 Rationale

Rationale: Alphabetic Index look for Meniere’s disease > H81.0-. When the code is verified in the Tabular List, an additional 5th digit is required to specify laterality; bilateral is 5th digit 3.  

Per ICD-10-CM guideline II.H, if the diagnosis documented is qualified as probable during an inpatient admission, it is coded as if it was established.

Question 5 Rationale

Rationale: ICD-10-CM Alphabetic Index look for Foreign body > Intraocular > Old, retained (nonmagnetic) > Magnetic > Posterior wall > H44.64-.  

In the Tabular List, 6th character 1 is assigned for the right eye.  

Subcategory code H44.6 has instructions to use an additional code to identify the foreign body (Z18.11).  

Z18.11 identifies a retained magnetic fragment. Verify code selection in the Tabular List.