Today we are going to talk about Chapter 7
guidelines, Diseases of the Eye and
Adnexa. There were no changes to the
Coding Guidelines in 2017 so you are
free to use those guidelines there in
front of chapter 7 in your code book.
We'll start with some general information.
Assign as many codes from category H40
Glaucoma as needed to identify the type of
glaucoma, the affected eye and that
glaucoma stage. Most of the guidelines, in
fact, I think all the guidelines in this
chapter have to do with glaucoma. If a
patient's admitted with glaucoma and the stage
progresses during the admission, you're
going to assign the code for the highest
stage that was documented. You have an
example in this PowerPoint about that
and also when you assign the 7th
character "4" meaning indeterminate stage,
that is based on clinical documentation.
The 7th character "4" means the
physician cannot determine what stage it
is. That is not the same as a 7th
character "0" which means there is no
documentation to help the coder know what
stage. So different situations there for
how you would use that 7th character.
We have an example of that as well. The
first guideline has to do with bilateral
glaucoma, the same type and the same
stage. When a patient has bilateral
glaucoma in both eyes, documented as being
the same type, and the same stage, and there's a
code for bilateral, you only need the
code for the type of glaucoma, bilateral
with the 7th character for the stage. The
example we have here, bilateral severe
stage, pigmentary glaucoma. When you go to
index and you look up Glaucoma, pigmentary,
it sends you to glaucoma,
open-angle, primary, pigmentary. When you go
there, you get the H40.13- and when
you go back to the Tabular and look this
up. the 6th character, the number 3
indicates the condition is bilateral and
the 7th character the number three indicates
the stage which is severe. Bilateral
open-angle glaucoma not specified as to
type and a stage is indeterminate in
both eyes. So your guideline tells you
when a patient has bilateral glaucoma,
both eyes are the same type and stage
and the classification doesn't provide a
code for bilateral, you report only one
code for the type of glaucoma with the
appropriate seventh character for the
stage. So the glaucoma, open-angle takes
you to H40.10-, the 6th character
needs an "X" as a placeholder because you
have to have a 7th character to identify
the stage. Our scenario tells us that
the stage is indeterminate which is the
number "4" so this is a reminder in
this scenario. The patient has glaucoma,
the same type and stage of both eyes,
but there's no code specifically for
bilateral glaucoma. Only one code is
assigned with the appropriate 7th
character for the stage, which in this
case is indeterminate. Here's an example
of a bilateral glaucoma stage with
different types or stages..Bilateral
chronic angle-closure glaucoma. The right
eye is mild stage' the left eye is moderate
The documentation is there telling us
you've got both eyes involved but
different types or different stages. Correction it is the
same type, different stages so the guideline is when a
patient has bilateral glaucoma and each
eye documented as having a different type or
stage. Classification distinguishes
laterality. Assign the appropriate code
for each eye rather than the code for
bilateral.
In this case, this particular code H40.22-
does provide to the coder to
identify the eye with a 6th character and
the 7th character is the stage.
I have there how I assign the 6th and
7th characters. Another example,
documentation relates mild unspecified
primary angle-closure glaucoma of the
left eye with mild unspecified
open-angle glaucoma of the right eye. In
this case, they have different types of
glaucoma. The codes involved do not
distinguish laterality so we're going to
assign one code for each type of
glaucoma with the appropriate 7th
character for the stage and you see
there what I've done.
Patient admitted with glaucoma and the
stage evolves during the admission. You're
going to always code the highest stage
that's documented in the record. The example
that's given here- patient admitted
with mild low tension glaucoma of the
right eye progresses to a moderate stage
during the patient's stay.Going to the
index, low tension glaucoma takes us to
glaucoma,open-angle, primary, low tension
which takes us to H40.12-, that 6th
character "1" identifies the right eye. The
7th character "2" identifies the
moderate stage which we are coding
because it is the more severe of the two
stages that are listed there in the
scenario. If you have any questions
related to Chapter 7 guidelines, please
post them on discussion board. I think
it's pretty straightforward but easily
confused, so please look at the podcast
more than once. read through the guidelines several
times, look at examples to help you
distinguish between these different
things the guidelines are talking about.
Thank you so much.