ICD-10 Coding for Epiretinal Membrane(H35.379, H35.371)
Complete ICD-10-CM coding and documentation guide for Epiretinal Membrane. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epiretinal Membrane
H35.37Primary Range
Other retinal disorders
This range includes codes specific to epiretinal membrane conditions, with laterality distinctions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.379 | Puckering of macula, unspecified eye | Use when ERM is diagnosed but laterality is not specified. |
|
| H35.371 | Puckering of macula, right eye | Use when ERM is diagnosed in the right eye. |
|
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 epiretinal membrane
Essential facts and insights about Epiretinal Membrane
Primary ICD-10-CM Codes for epiretinal membrane
Decision Criteria
clinical Criteria
- Presence of hyperreflective membrane on OCT
documentation Criteria
- Lack of specified laterality
Applicable To
- Epiretinal membrane
Excludes
- Macular hole (H35.34)
Clinical Validation Requirements
- OCT findings showing hyperreflective membrane
- Visual symptoms such as metamorphopsia
Code-Specific Risks
- Risk of unspecified laterality leading to audit issues.
Coding Notes
- Ensure documentation specifies OCT findings and visual symptoms.
H35.371 - Puckering of macula, right eye
Use when ERM is diagnosed in the right eye.
Applicable To
- Epiretinal membrane, right eye
Excludes
- Macular hole (H35.34)
Clinical Validation Requirements
- OCT findings showing hyperreflective membrane in the right eye
- Visual symptoms such as metamorphopsia in the right eye
Coding Notes
Ensure documentation specifies laterality and OCT findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
OCT imaging
92134Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Macular hole
H35.34Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Epiretinal Membrane to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.379.
Impact
Clinical: Impacts treatment planning and outcomes., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always document laterality in the assessment and plan., Use laterality-specific codes.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Ensure laterality is documented and use specific codes H35.371 or H35.372.
Impact
High risk of audit if laterality is not documented.
Mitigation Strategy
Implement mandatory laterality documentation in EHR systems.
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 Epiretinal Membrane, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epiretinal Membrane
Use these documentation templates to ensure complete and accurate documentation for Epiretinal Membrane. These templates include all required elements for proper coding and billing.
ERM diagnosis with surgical intervention
Specialty: OphthalmologyRequired Elements
- Visual acuity measurements
- OCT findings
- Surgical plan and notes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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