ICD-10 Coding for Macular Dystrophy(H35.52)
Complete ICD-10-CM coding and documentation guide for Macular Dystrophy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Macular Dystrophy
H35.5Primary Range
Hereditary retinal dystrophies
This range includes various forms of hereditary macular dystrophies, which are genetic in nature and distinct from age-related macular degeneration.
Key Information: ICD-10 code for macular dystrophy
Essential facts and insights about Macular Dystrophy
Primary ICD-10-CM Code for macular dystrophy
Decision Criteria
clinical Criteria
- Genetic confirmation of dystrophy
documentation Criteria
- Detailed retinal imaging findings
Applicable To
- Retinitis pigmentosa
- Butterfly-shaped macular dystrophy
Clinical Validation Requirements
- Genetic testing confirming mutations in genes such as ABCA4, RP1L1
- OCT showing foveal ellipsoid zone disruption
- mfERG showing central dysfunction
Code-Specific Risks
- Confusing with age-related macular degeneration codes
- Not specifying genetic confirmation
Coding Notes
- Ensure genetic confirmation and specific documentation of retinal changes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Macular Dystrophy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.52.
Impact
Clinical: Misdiagnosis and inappropriate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure genetic testing is ordered and results documented., Educate staff on documentation requirements.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification of hereditary conditions as age-related., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Ensure genetic testing and specific retinal findings are documented.
Impact
Lack of documentation for genetic testing can lead to audit findings.
Mitigation Strategy
Ensure all genetic testing is documented in the patient's record.
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 Dystrophy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Macular Dystrophy
Use these documentation templates to ensure complete and accurate documentation for Macular Dystrophy. These templates include all required elements for proper coding and billing.
Diagnosis of hereditary macular dystrophy
Specialty: OphthalmologyRequired Elements
- Genetic test results
- OCT findings
- Family history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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