Eye Pain ICD 10 – What’s new in 2021?

November 9, 2021

Eye pain

The year 2021 marks the sixth update to the ICD 10 codes since the day the code set went live in October 2015. Each year, the code set is revised and all the healthcare providers must adhere to the changes to avoid any delays in the reimbursement process.

Correct, complete coding is essential for an optometry practice as it serves as the foundation for collecting the payment for the services provided. For that, the eye care provider must be aware of the latest eye-related codes added, modified or deleted from the ICD 10 and if their administration is ready for the updates.

The new code changes in the latest revision of the ICD-10-CM incorporates almost 600 changes in codes, including 490 new additions, 58 deletions and 47 revised codes. In this article, we look at one of the most common conditions presented to eye care providers, eye pain ICD 10, the major changes in the eye related sections and the steps to stay ahead in your practice from the perspective of medical coding and billing.

Types of Eye Pain

Eye pain is a fairly common condition that is rarely an indication of a serious issue. Most of the time, the pain diminishes without any treatment or medicine. Depending on the type of discomfort, eye pain can fall into either of the following categories:

Surface Pain

Pain experienced on the front surface of the eye is commonly caused by a corneal foreign body. Common foreign bodies include inorganic grit, organic material and sawdust. Once the foreign bodies get embedded in the cornea, it causes discomfort ranging from mild to severe, especially causing distress when blinking. Sensitivity to light and blurred vision are also common symptoms.

A scratched cornea, or corneal abrasion, is another source of pain on the eye’s surface. The person would have watery eyes and be more sensitive to light. Superficial scratches are rarely dangerous and heal in at most 24 hours. But deeper abrasions could lead to an eye infection and even a corneal ulcer.

A corneal abrasion is usually brought on by dry eyes, a condition where there are not enough tears on the eye’s surface to keep the cornea slippery and moist. Most of the time, dry eyes do not require urgent attention, but it is important to get effective treatment before it gets worse.

Inner Eye Pain

Pain behind the eyes is often caused by a sinus infection or in most cases migraines. For the latter, the pain is always behind one eye and goes on to affect the same side of the head, while the latter distresses both the eyes.

Pain Around the Eyes

Pain around the eyes is most commonly caused by a hordeolum, or a stye in the eyelid. It can be treated at home by applying warm compresses that can cause the stye to diminish over a few days. In a few cases, blepharitis causes swelling in the eyelids that can cause pain around the eye.

About the ICD 10

The International Classification of Diseases tenth revision is a clinical system applied by healthcare providers and physicians to code and classify the diseases, diagnoses, symptoms and procedures that are recorded during health care provided. The ICD 10 is important to compile diagnostic specificity and morbidity data in the US.

The International Classification of Diseases is published by the World Health Organization, used by physicians, health information managers, coders, nurses and other professionals associated with the healthcare sector for storage and retrieval of information relating to diagnosis. In the bigger picture, the data is compiled to provide national morbidity and mortality statistics.

The ICD 10 comprises known disease and health problems listed in a systematic way, and uses unique alphanumeric codes that correspond to each disease and condition to make identification easy. After the ICD 10 was formally regulated in the US health system, all HIPAA (Health Insurance Portability and Accountability Act) compliant/covered entities are required to adhere to the ICD 10 code sets.

ICD 10 code for Pain

H57.10 is the eye pain ICD 10 code assigned in the latest revision of the code set. The code is used most commonly to categorize cases of ocular pain, unspecified eye. Ophthalmologists use it to indicate a diagnosis for claims reimbursements for the health care provided. H57.10 is under the H00-H59 (Disease of the eye and adnexa) category which contains annotation back-reference to eye pain.

According to the guidelines, H57.10 can be used to describe both pain in or around eye ICD 10. Additional synonyms include pain in eye, eye pain and periorbital pain.

As per the ICD 10, any case that is characterized by a marked discomfort or a painful sensation in or around the eye should be coded under H57.10 ICD 10 eye pain.

Updates for Ophthalmologists in the ICD-10-CM 2021

The ICD 10 is revised each year, with the addition, removal and alteration of hundreds of codes. The 2021 version of the ICD-10-CM saw over 500 updates overall, with 72 of them concerning eye-related diseases and encounters. The major changes affect the following chapters:

Chapter 7 (H00-H59): In the Diseases of the eye and adnexa, the new corneal dystrophies add one digit at the end of the codes to stipulate laterality. New codes for deficient smooth pursuit eye movements and saccadic eye movements are added.

Chapter 19 (S00-F88): The chapter for injury, poisoning and certain other consequences of external causes describes codes for corneal transplant complications, such as infection, failure or rejection. The codes are added with an additional digit to specify laterality.

Steps to Stay Ahead

When coding for ICD 10 eye pain or other health issues it is important to be aware of the latest updates and changes in the code set, to avoid any financial issues in the practice. Here are some tips to help with medical billing and coding:

  • Get familiar with the most commonly used optometry and ophthalmology codes and periodically review the new, revised and deleted codes.
  • Create a ‘most used’ list and make it a habit to frequently go through it and make changes to it as per revisions.
  • Review plans, assessments, and outbound documents in your optometric software, and map old codes to the new codes.
  • Reach out to the American Academy of Ophthalmology and the American Optometric Association to find out about the recent coding changes and any additional resources on the guidelines for correct coding.

Conclusion

Being well-versed in medical coding may not be the priority of every doctor. But it still is vital to get timely reimbursements from the insurers. Moreover, in places where there is managed care, having a know-how of codes can provide you with a wealth of data that can be used for contract negotiations and practice profiling. The codes are also analyzed by the federal government to detect cases of fraud and embezzlement, so it is more important than ever to brush up your coding skills or outsource your coding tasks to an established and well reputed medical billing organization.

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