ICD-10 Coding for Eye Cataract(H25.11, H26.33)
Complete ICD-10-CM coding and documentation guide for Eye Cataract. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Eye Cataract
H25-H26Primary Range
Cataract
This range includes all types of cataracts, including age-related, congenital, and secondary cataracts.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H25.11 | Age-related nuclear cataract, right eye | Use when nuclear sclerosis is documented and affects daily activities. |
|
| H26.33 | Drug-induced cataract, bilateral | Use when cataract is confirmed to be drug-induced. |
|
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 age-related cataract
Essential facts and insights about Eye Cataract
Primary ICD-10-CM Codes for eye cataract
Decision Criteria
clinical Criteria
- Nuclear sclerosis with BCVA ≤20/40
Applicable To
- Nuclear sclerosis
Excludes
- Traumatic cataract (H26.1)
Clinical Validation Requirements
- Documented nuclear sclerosis
- BCVA ≤20/40 impacting ADLs
Code-Specific Risks
- Incorrect laterality
- Lack of specific documentation
Coding Notes
- Ensure laterality is specified.
H26.33 - Drug-induced cataract, bilateral
Use when cataract is confirmed to be drug-induced.
Applicable To
- Cataract due to steroid use
Excludes
- Age-related cataract (H25.-)
Clinical Validation Requirements
- History of steroid use
- Slit-lamp confirmation of posterior subcapsular opacity
Coding Notes
Document drug history clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified glaucoma
H40.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Eye Cataract to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.11.
Impact
Clinical: May lead to unnecessary surgeries., Regulatory: Non-compliance with Medicare requirements., Financial: Potential claim denials.
Mitigation Strategy
Include detailed vision testing results, Document patient-reported difficulties
Impact
Reimbursement: May lead to claim denials or reduced payments., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Always document and code the specific type and laterality of cataract.
Impact
Inadequate documentation of complex procedures can lead to audit issues.
Mitigation Strategy
Ensure all devices and techniques are documented in the operative report.
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 Eye Cataract, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Eye Cataract
Use these documentation templates to ensure complete and accurate documentation for Eye Cataract. These templates include all required elements for proper coding and billing.
Cataract Surgery Pre-Op
Specialty: OphthalmologyRequired Elements
- Chief Complaint
- BCVA
- Glare Testing
- Slit-Lamp Findings
- Management Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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