ICD-10 Coding for Eye Pain(H57.10, H57.11, H57.12, H57.13)
Complete ICD-10-CM coding and documentation guide for Eye Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Eye Pain
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H57.10 | Unspecified eye pain | Use when eye pain is present but not further specified. |
|
| H57.11 | Right eye pain | Use when pain is specifically in the right eye. |
|
| H57.12 | Left eye pain | Use when pain is specifically in the left eye. |
|
| H57.13 | Bilateral eye pain | Use when pain is present in both eyes. |
|
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: How is eye pain coded in ICD-10?
Essential facts and insights about Eye Pain
Primary ICD-10-CM Codes for eye pain
Decision Criteria
documentation Criteria
- Document specific laterality and characteristics of pain.
Applicable To
- General eye pain
Excludes
- Pain due to foreign body (S05.9)
Clinical Validation Requirements
- Documented eye pain without specific laterality or cause.
Code-Specific Risks
- Risk of under-documentation if laterality is known.
Coding Notes
- Ensure laterality is documented when known.
H57.11 - Right eye pain
Use when pain is specifically in the right eye.
Applicable To
- Pain localized to the right eye
Excludes
- Pain due to foreign body (S05.9)
Clinical Validation Requirements
- Pain specifically documented in the right eye.
Coding Notes
Document any associated symptoms or findings.
H57.12 - Left eye pain
Use when pain is specifically in the left eye.
Applicable To
- Pain localized to the left eye
Excludes
- Pain due to foreign body (S05.9)
Clinical Validation Requirements
- Pain specifically documented in the left eye.
Coding Notes
Document any associated symptoms or findings.
H57.13 - Bilateral eye pain
Use when pain is present in both eyes.
Applicable To
- Pain in both eyes
Excludes
- Pain due to foreign body (S05.9)
Clinical Validation Requirements
- Pain documented in both eyes.
Coding Notes
Document any associated symptoms or findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Eye Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H57.10.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always include laterality in documentation., Use templates to ensure completeness.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with documentation standards., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Specify laterality using H57.11, H57.12, or H57.13.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement documentation templates that require laterality.
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 Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Eye Pain
Use these documentation templates to ensure complete and accurate documentation for Eye Pain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Eye Pain
Specialty: OphthalmologyRequired Elements
- Laterality
- Pain characteristics
- Associated symptoms
- Objective findings
- Clinical decision
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Eye Pain? Ask your questions below.