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    ICD-10 diaries: The first days of implementation

    As the ICD-10 implementation deadline approached, we asked several practitioners to document their experiences leading up to and the days after implementation.

    Just like ODs around the country, each doctor prepared for ICD-10 in different ways, so they each experienced implementation differently. Their notes below reflect that.


    Related: ICD-10: Not quite the end of days


    Ernie Bowling, OD, FAAO
    Gadsden, AL


    Sept. 28, 2015
    OK, this is the week. I have gotten all the resources I know and attended several ICD-10 preparatory classes, so we'll see how this all goes. Don't think this is going to be Armageddon.

    First patient was a glaucoma suspect ICD-9 365.01. In this case, the ICD-10 conversion is H40.013. Isn't this going to be wonderful? Second patient was again a glaucoma suspect just like above—bilateral H40.013. Third patient was a run-of-the-mill nuclear cataract: 366.16 under the old ICD-9, H25.13 with ICD-10.

    The next three were purely refractive diagnoses: myopia 367.1 to H52.13; presbyopia 367.4 to H52.4: astigmatism 367.2 to H52.203. Then walked in a corneal foreign body. The ICD-9 code is 918.1; the ICD-10 code S05.01XA. Next came a lid myokymia: ICD-10 H02.422.

    What followed was another refractive case: presbyopia (H52.4). I can see this is going to be a little time-consuming, at least initially. Where before I knew these ICD-9 codes by heart, looking up the ICD-10 codes takes just a little time. So, I’m going to have my tech do it. Delegate!

    The last morning patient was a secondary cataract: 366.53 with the old code, now H26.493, so sayeth my tech, somewhat sheepishly.

    So, following a light lunch starts the afternoon patients. Begins with another cataract (H25.13). Then a patient with bilateral hypertensive retinopathy (H35.033). Followed by a simple myope (H52.13). Bilateral, don't you know. Next comes a bilateral hyperope (H52.03) with a refractive amblyopic LE (H53.022). 

    The next patient is a degenerative myope (H44.23).

    The next two cases were interesting: A mother and son who both have a refractive amblyopia, him in the right eye (H53.021), her in the left (H53.022). The mother also has an iris nevus in the right eye (H21.231). The next patient presented with some vitreous floaters of the left eye (H43.312). Another simple myope, bilateral (H52.13).

    Closed out clinic with another simple hyperope (H52.03), then a patient presenting with an acute allergic conjunctivitis in the left secondary to a bee sting (H10.212).


    Sept. 29, 2015

    I should say that we’ve been attempting to chart both ICD-9 and ICD-10 for the last few weeks, but we haven’t been diligent with it. Still, the limited experience has helped with the dry run.

    I started today off with a patient with dry eye: 375.15 in ICD-9, ICD-10 H04.123. The next patient had two marginal corneal ulcers in his right eye (H16.041). The next patient was a simple bilateral myope (H52.13). Our next patient was very charming elderly lady with a dry eye bilaterally (H04.123) and dry macular degeneration (H35.31). This was followed by two simple myopes (H52.13) and a routine exam without any ocular findings (Z01.00). I am using this code because it is the one that I have heard the most about for routine use. There is a "Z" code for routine exam with ocular findings, which I assume to mean ocular pathology, which means it isn’t routine.

    That routine exam was followed by a patient with peripheral lattice degeneration of the retina bilaterally (H35.413). And we finished the morning with a patient who has mild non-proliferative diabetic retinopathy without macular edema bilaterally (E11.329).

    The afternoon clinic started off with a series of three cataract evaluations: old ICD-9 366.19, new ICD-10 H25.11 (right eye), H25.12 (left eye), and H25.13 (NSC bilaterally). That was followed by a nice lady with dry macular degeneration (H35.31), then two routine myopes (H52.13). Hey—I remembered this one. 

    One cataract post-op; this is a 366.19 and will convert to H25.812 (right eye).Then a glaucoma suspect: old 365.01, new H40.013 bilateral. A new patient with a posterior subcapsular cataract in the left eye (H25.042) followed. And I finished the day with another simple myope (H52.13). 


    Sept. 30, 2015

    Well, today's the day before ICD-10 Armageddon, so I took the morning off.

    My first patient of the day was a conjunctival laceration of the left eye (S05.02XA), followed by an epidemic keratoconjunctivitis OU (B30.1/077.4). The next patient was a bilateral simple hyperope (H52.03), followed by a myopic presbyope (H52.13/H52.4). The next patient presented with a chronic allergic conjunctivitis bilaterally (H10.45) and a hyperopic presbyope (H52.03/H52.4). This was followed by myopic presbyope (H52.13/H52.4) with Grade 1 hypertensive retinopathy (H35.033) and then a patient who is in for post-op dermatochalasis (H02.839) repair. The day ended with another simple myopic astigmat (H52.13/H52.203) and a keratoconic (H18.623) patient presenting for a scleral lens fit.



    Ernie Bowling, OD, MS, FAAO
    Dr. Ernie Bowling is Chief Optometric Editor of Optometry Times. He received his Doctor of Optometry and Master of Science in ...
    Carl H. Spear, OD, MBA, FAAO
    Dr. Spear owns a multi-location group practice with his wife Dr. Katie Gilbert Spear in Pensacola, FL. Dr. Spear is commander of the ...
    Mile Brujic, OD, FAAO
    Dr. Mile Brujic practices in Bowling Green, OH. He also owns Optometric Insights, a service providing career coaching to optometrists.


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