ICD-10 Coding for Macular Degeneration(H35.31, H35.32)
Complete ICD-10-CM coding and documentation guide for Macular Degeneration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Macular Degeneration
H35.31-H35.34Primary Range
Degeneration of macula and posterior pole
This range includes codes for different types and stages of macular degeneration, which are critical for accurate diagnosis and treatment planning.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.31 | Nonexudative age-related macular degeneration | Use for patients with dry AMD, specifying laterality and stage. |
|
| H35.32 | Exudative age-related macular degeneration | Use for patients with wet AMD, specifying laterality and activity status. |
|
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 macular degeneration
Essential facts and insights about Macular Degeneration
Primary ICD-10-CM Codes for macular degeneration
Decision Criteria
clinical Criteria
- Presence of drusen without fluid on OCT
documentation Criteria
- Detailed staging and laterality
Applicable To
- Dry AMD
Excludes
- Exudative AMD (H35.32)
Clinical Validation Requirements
- Fundus photography showing drusen
- OCT confirming absence of fluid
Code-Specific Risks
- Incorrect staging documentation can lead to coding errors.
Coding Notes
- Ensure documentation specifies drusen size and presence of geographic atrophy.
H35.32 - Exudative age-related macular degeneration
Use for patients with wet AMD, specifying laterality and activity status.
Applicable To
- Wet AMD
Excludes
- Nonexudative AMD (H35.31)
Clinical Validation Requirements
- OCT showing subretinal or intraretinal fluid
- Fluorescein angiography confirming CNV
Coding Notes
Document treatment response and follow-up imaging.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Macular Degeneration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.31.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential claim denials.
Mitigation Strategy
Use templates with required fields, Regular training on documentation standards
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure documentation matches the coded laterality.
Impact
Inadequate documentation of treatment intervals can lead to audit findings.
Mitigation Strategy
Ensure all treatment dates and intervals are clearly documented.
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 Macular Degeneration, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Macular Degeneration
Use these documentation templates to ensure complete and accurate documentation for Macular Degeneration. These templates include all required elements for proper coding and billing.
Wet AMD with active CNV
Specialty: OphthalmologyRequired Elements
- Laterality
- Activity status
- OCT findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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