Question

Sherald is having trouble finding a procedural code in the Alphabetic Index for removal of a cataract. What are some options and/or alternative ways she can perform an Alphabetic Index search?

Answer 1

Ans.

the alphabetic index in medical coding

Alphabetic Index: An alphabetical list of ICD-10-CM (Clinical Modification) terms and their corresponding codes, which helps to determine which section to refer to in the Tabular List. It does not always provide the full code.

the ICD 10 code for cataract surgery-

Z98.49

Cataract extraction status, unspecified eye

Z98. 49 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM Z98.

Brackets are used in the Alphabetic Index to identify manifestation codes. Parentheses ( ) are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned

The Alphabetical Index of diagnostic terms (plus their corresponding ICD-10 codes) lists thousands of “main terms” alphabetically. Under each of those main terms, there is often a sublist of more-detailed terms—for instance, “Cataract” has a sublist of 84 terms. However, the Alphabetical Index doesn’t include coding instructions, which are in the Tabular List.

The Tabular List of ICD-10 codes (plus their descriptors) is organized alphanumerically from A00.0 to Z99.89. It is divided into chapters based on body part or condition. Most ophthalmology codes are in chapter 7 (Diseases of the Eye and Adnexa), but diabetic retinopathy codes are in chapter 4 (Endocrine, Nutritional, and Metabolic Diseases).

Order the lists today. Both can be downloaded from the CMS website (www.cms.gov/icd10). For ophthalmologists, however, the most user-friendly option is the ICD-10-CM for Ophthalmology: The Complete Reference, which is available in print or as an online subscription. Another key reference is the Ophthalmic Coding Coach, which will help you link CPT codes to ICD-10 codes.

A Five-Step Process

Step 1: Search the Alphabetical Index for a diagnostic term. After identifying the term, note its ICD-10 code.

Tip. The term you’re looking for might not be one of the main terms in the index, but it might be listed under one of those main terms. For instance, “Congenital cataract” is listed under “Cataract.” But it isn’t always that easy—“Horseshoe tear of the retina (without detachment)” is listed under “Break, retina,” and “Floppy iris syndrome” is listed under “Floppy.”

Step 2: Check the Tabular List. Before you use the ICD-10 code that you found in the Alphabetical Index, it is important to check that code in the Tabular List to see if there are special instructions.

Example. If you looked only at the Alphabetical Index, you wouldn’t know that some glaucoma diagnosis codes require a sixth character to represent laterality—1 for the right eye, 2 for the left eye, and 3 for both eyes—or a seventh character to represent staging (see “Step 5”).

Step 3: Read the code’s instructions. The code’s entry in the Tabular List provides all the diagnosis code requirements.

Example. The Tabular List flags any codes that can’t be submitted for the same eye on the same day

Step 4: If it is an injury or trauma, add a seventh character. Use one of the following:

• A to indicate the initial encounter
• D for a subsequent encounter
• S for sequela

Example. A patient presents with a complaint of pain in the right eye for two hours. A corneal abrasion is diagnosed. The code is S05.01 Injury of conjunctiva and corneal abrasion without foreign body, right eye. That code’s entry in the Tabular List instructs you to add a seventh character—A, D, or S. Since S05.01 is only five characters long, use X as a placeholder in the sixth position. In the seventh position, add A to indicate an initial encounter—S05.01XA. When the patient is seen in follow-up, use code S05.01XD. If the patient develops a recurrent erosion as a result of the abrasion, use code S05.01XS.

Step 5: If glaucoma, you may need to add a seventh character. For some diagnoses, the Tabular List instructs you to add a seventh character for glaucoma staging codes:

• 0 for stage unspecified
• 1 for mild
• 2 for moderate
• 3 for severe
• 4 for indeterminate

Example. The ICD-10 code H40.2232 represents bilateral chronic angle-closure glaucoma, moderate stage. Breaking that down, H40.22 represents chronic angle-closure glaucoma, the 3 in the sixth position indicates that it is bilateral, and the 2 in the seventh position represents that it is moderate stage.

Always code to the highest degree of accuracy and completeness. If there is a fourth, fifth, sixth, or seventh digit available, you must use it.