ICD-10 Coding for Left Eye Cataract(H25.11, H25.12)
Complete ICD-10-CM coding and documentation guide for Left Eye Cataract. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Eye Cataract
H25.1-H25.9Primary Range
Age-related cataract
This range includes specific codes for age-related cataracts, which are the most common type affecting the left eye.
Other cataracts
This range includes codes for other types of cataracts, such as complicated or drug-induced 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, left eye | Use when nuclear sclerosis is the primary type of cataract affecting the left eye. |
|
| H25.12 | Combined forms of age-related cataract, left eye | Use when both nuclear and cortical cataracts are present in the left 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 left eye cataract
Essential facts and insights about Left Eye Cataract
Primary ICD-10-CM Codes for left eye cataract
Decision Criteria
clinical Criteria
- Presence of nuclear sclerosis confirmed by slit-lamp exam
Applicable To
- Nuclear sclerosis of the left eye
Excludes
- Cataract in other specified diseases classified elsewhere
Clinical Validation Requirements
- Best-corrected visual acuity (BCVA) testing
- Slit-lamp examination showing nuclear sclerosis
Code-Specific Risks
- Incorrectly coding as unspecified cataract
Coding Notes
- Ensure laterality is documented as left eye.
H25.12 - Combined forms of age-related cataract, left eye
Use when both nuclear and cortical cataracts are present in the left eye.
Applicable To
- Mixed nuclear and cortical cataract
Excludes
- Cataract in other specified diseases classified elsewhere
Clinical Validation Requirements
- BCVA testing
- Slit-lamp examination showing mixed cataract types
Coding Notes
Document both nuclear and cortical components.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Primary open-angle glaucoma, severe stage
H40.11X3Differential 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 Left 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 incomplete assessment of visual impairment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Include glare testing in preoperative assessment, Document results in clinical notes
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with specificity requirements., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always specify laterality and type of cataract.
Impact
Audits often target unspecified cataract codes.
Mitigation Strategy
Use specific codes with documented laterality and type.
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 Left Eye Cataract, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Eye Cataract
Use these documentation templates to ensure complete and accurate documentation for Left Eye Cataract. These templates include all required elements for proper coding and billing.
Age-related nuclear cataract with premium IOL
Specialty: OphthalmologyRequired Elements
- Patient-reported symptoms
- BCVA and refraction results
- Cataract type and laterality
- IOL model and serial number
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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