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Test Your Coding Competency","","Coding & Reimbursement Savvy Coder tests ICD-10 coding competency through three ophthalmology claim scenarios involving conjunctivitis with an Excludes1 restriction, concurrent glaucoma and cataract billing linkage, and a lesion case where suspected pathology should not be coded as a confirmed malignancy. Each section answers why a claim would be denied, clarifies correct ICD-10/CPT diagnosis pointer linking on CMS-1500, and provides practical takeaway rules to prevent denials and medical review. Includes references to AAOE ICD-10 resources and the 2022 ICD-10-CM for Ophthalmology manual.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/how-well-do-you-know-icd-10-test-your-coding-competency/469555/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/how-well-do-you-know-icd-10-test-your-coding-competency/469555.png","ImageObject",300,407,{"name":92,"@type":93},"Đào","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-24","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was the exam claim denied in the conjunctivitis scenario?","Question",{"text":112,"@type":113},"The ICD-10 subchapter H10 has an Excludes1 note for keratoconjunctivitis (H16.2-). Submitting ICD-10 codes with an Excludes1 note can prompt a payer to deny the claim, so only the code reflecting the exam reason should be reported.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How should the CPT codes be linked to ICD-10 codes for the glaucoma and cataract case?",{"text":117,"@type":113},"The glaucoma diagnosis code should link to 92083, and the cataract diagnosis code should link to 92136. Linking all three diagnoses to each CPT could lead to claim denials or a medical review based on medical necessity.",{"name":119,"@type":110,"acceptedAnswer":120},"What ICD-10 coding should be used when a lesion is still suspected before pathology confirmation?",{"text":121,"@type":113},"Do not link a CPT code to a “probable,” “suspected,” “possible,” or “rule-out” ICD-10 code. Use D48.1 for neoplasm of uncertain behavior prior to receiving the pathology report, or hold the claim until diagnosis is confirmed.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},469555,1792811413,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81},1374402968488,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","CODING & REIMBURSEMENT  \nSAVVY CODER  \nHow Well Do You Know ICD-10? Test Your Coding Competency  \nRemember the launch of ICD-  \n10 in 2015? New definitions,  \nexpanded specificity and laterality, and a crosswalk from the old codes to new codes—these were at the core of the learning curve. Since then, practices’experiences with claims denials and claims reviews have further clarified the ICD-10 rules.  \nTackle the questions below to test your coding competency and improve  \nyour mastery of some core ICD-10 principles.  \nA Claim for an Exam Is Denied A claim for an exam was submitted with ICD-10 codes H10.012 acute follicular conjunctivitis, left eye and H16.223 keratoconjunctivitis sicca, bilateral.  \nQ. Why was this claim denied?  \nA. ICD-10’s subchapter for conjunctivitis, H10, has an Excludes1 note forkeratoconjunctivitis (H16.2-) . Submitting ICD-10 codes with an Excludes1 note can prompt a payer to deny the claim. For this claim, report only the one ICD-10 code that reflects the reason for the exam.  \nTakeaway point. The ICD-10 rules use Excludes1 notes to flag codes that you can’t submit together. These notes are used when two conditions cannot occur together. For example, a congenital condition (e.g., Q10.2 congenital entropion) can’t also be an acquired condition (e.g., H02.02-mechanical entropion) .  \nA Patient With Concurrent Glaucoma and Cataract  \nThe physician orders a visual field test and an IOLMaster (Zeiss) test. When billing for those services, the practice used CPT code 92083 to report the visual field test and 92136 for the IOLMaster test. In the superbill, the practice linked the following three ICD-10 codes to both those services:  \nH25.11 age-related cataract, right eye; H40.1131 bilateral primary open-angle glaucoma, mild stage; and E11.9 Type 2 diabetes without complication.  \nQ. Are the CPT codes linked to ICD- 10 codes correctly?  \nA. No. The glaucoma diagnosis code alone should be linked to 92083 and the cataract diagnosis code alone to 92136. Linking all three diagnosis codes to each of those CPT codes could lead to claim denials or a focused medical review based on medical necessity.  \nTakeaway point. A CPT code should be linked only to the ICD-10 code that supports medical necessity for the service provided. On the CMS-1500 form, or its electronic equivalent, make sure that each CPT code reported is linked to an appropriate ICD-10 code (or codes) . Each of the encounter’s ICD-10 codes should be listed in item 21 of the form. The form has space to list up to 12 ICD-10 codes, and each one is assigned a letter (“A” through “L”) . These letters are used in column E (the“Diagnosis Pointer” column) of item  \nBY JOY WOODKE, COE, OCS, OCSR, ACADEMY DIRECTOR OF CODING AND REIMBURSEMENT.  \n24 to link each of the encounter’s CPT codes to an ICD-10 code.  \nSending a Lesion to the Lab  \nA lesion is removed from the right eyelid and sent to pathology for a confirmatory diagnosis. The assessment in the chart documents suspected malignant neoplasm.  \nQ. Is it appropriate to code as C44.102 unspecified malignant neoplasm of skin of right eyelid?  \nA. No. It is not appropriate to report an ICD-10 code for a suspected condition. You have two options: Hold the claim until a diagnosis is confirmed or code based on the current assessment. D48.1, neoplasm of uncertain behavior, would accurately represent the diagnosis prior to receiving the pathology report.  \nTakeaway point. Do not link a CPT code to a “probable,” “suspected,”“possible,” or “rule-out” ICD-10 code. Instead, link to a confirmed diagnosis.  \nUse These AAOE Resources  \n[Bookmark](Bookmark aao.org/icd10. Brush)[ aao.org/icd10](Bookmark aao.org/icd10. Brush)[.](Bookmark aao.org/icd10. Brush)[ Brush](Bookmark aao.org/icd10. Brush) upon the ICD-10 coding fundamentals by visiting [aao.org/icd10](aao.org/icd10. The)[. The](aao.org/icd10. The) latest versions of subspecialty specific guides and decision trees are available to download for free.  \nBuy eye care’s I","cbCaigbOKzeni5hv","https://ap.wps.com/l/cbCaigbOKzeni5hv","pdf",68038,"English","# How Well Do You Know ICD-10? Test Your Coding Competency\n## A Claim for an Exam Is Denied\n## A Patient With Concurrent Glaucoma and Cataract\n## Sending a Lesion to the Lab\n## Use These AAOE Resources","[{\"question\":\"Why was the exam claim denied in the conjunctivitis scenario?\",\"answer\":\"The ICD-10 subchapter H10 has an Excludes1 note for keratoconjunctivitis (H16.2-). Submitting ICD-10 codes with an Excludes1 note can prompt a payer to deny the claim, so only the code reflecting the exam reason should be reported.\"},{\"question\":\"How should the CPT codes be linked to ICD-10 codes for the glaucoma and cataract case?\",\"answer\":\"The glaucoma diagnosis code should link to 92083, and the cataract diagnosis code should link to 92136. Linking all three diagnoses to each CPT could lead to claim denials or a medical review based on medical necessity.\"},{\"question\":\"What ICD-10 coding should be used when a lesion is still suspected before pathology confirmation?\",\"answer\":\"Do not link a CPT code to a “probable,” “suspected,” “possible,” or “rule-out” ICD-10 code. Use D48.1 for neoplasm of uncertain behavior prior to receiving the pathology report, or hold the claim until diagnosis is confirmed.\"}]","How Well Do You Know ICD-10? Test Your Coding Competency | PDF",1790775833]