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ICD-10 Coding for Endophthalmitis(H44.0, H44.1, A54.39)

Complete ICD-10-CM coding and documentation guide for Endophthalmitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Intraocular infectionPurulent endophthalmitis

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Related ICD-10 Code Ranges

Complete code families applicable to Endophthalmitis

H44.0-H44.1Primary Range

Disorders of globe, including purulent and chronic endophthalmitis

This range includes codes for both acute purulent and chronic endophthalmitis, which are the primary conditions under endophthalmitis.

A54.39

Gonococcal endophthalmitis

Used when endophthalmitis is caused by Neisseria gonorrhoeae.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
H44.0Purulent endophthalmitisUse for acute infectious cases with purulence or microbial confirmation.
  • Vitreous tap with positive culture
  • B-scan ultrasound showing vitreous opacities
H44.1Chronic endophthalmitisUse for non-infectious or persistent inflammation cases.
  • Chronic symptoms persisting over 3 months
  • Exclusion of acute infectious causes
A54.39Gonococcal endophthalmitisUse when endophthalmitis is confirmed to be caused by gonococcal infection.
  • Positive culture for Neisseria gonorrhoeae

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for purulent endophthalmitis

Essential facts and insights about Endophthalmitis

The ICD-10 code for purulent endophthalmitis is H44.0, used for acute infectious cases with confirmed purulence.

Primary ICD-10-CM Codes for endophthalmitis

H44.0
Purulent endophthalmitis
Non-billable Code

Decision Criteria

clinical Criteria

  • Presence of purulent inflammation confirmed by lab tests.

Applicable To

  • Acute purulent endophthalmitis

Excludes

  • Chronic endophthalmitis (H44.1-)

Clinical Validation Requirements

  • Vitreous tap with positive culture
  • B-scan ultrasound showing vitreous opacities

Code-Specific Risks

  • Risk of using without confirmation of purulence.

Coding Notes

  • Ensure documentation specifies purulence and laterality.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Streptococcus as the cause of diseases classified elsewhere

B95.6
Use to specify the causative organism when identified.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Chronic endophthalmitis

H44.1
Use for persistent inflammation lasting more than 3 months.

Purulent endophthalmitis

H44.0
Use for acute cases with purulence.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Endophthalmitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H44.0.

Impact

Clinical: Ambiguity in treatment records., Regulatory: Potential for coding errors., Financial: Denial of claims due to unspecified codes.

Mitigation Strategy

Always document the affected eye(s).

Impact

Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Verify documentation for purulence and microbial confirmation.

Impact

Using unspecified codes can trigger audits.

Mitigation Strategy

Ensure documentation supports specific coding.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Endophthalmitis, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Endophthalmitis

Use these documentation templates to ensure complete and accurate documentation for Endophthalmitis. These templates include all required elements for proper coding and billing.

Acute post-surgical endophthalmitis

Specialty: Ophthalmology

Required Elements

  • Visual acuity
  • Pain level
  • Onset and duration
  • Procedure history
  • Lab results

Example Documentation

Patient presents with acute vision loss OD, 3 days post-cataract surgery. VA: HM OD. Vitreous tap positive for Staphylococcus.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Eye infection post-surgery.
Good Documentation Example
Acute purulent endophthalmitis OD, post-cataract surgery, Staphylococcus aureus confirmed.
Explanation
The good example specifies the type, laterality, and causative organism.

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