ICD-10 Coding for Optic Neuritis(H46.11, H46.12, H46.0)
Complete ICD-10-CM coding and documentation guide for Optic Neuritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Optic Neuritis
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H46.11 | Acute retrobulbar neuritis, right eye | Use when optic neuritis is confirmed in the right eye with clinical validation. |
|
| H46.12 | Acute retrobulbar neuritis, left eye | Use when optic neuritis is confirmed in the left eye with clinical validation. |
|
| H46.0 | Optic papillitis | Use when optic neuritis presents with optic disc edema. |
|
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 optic neuritis
Essential facts and insights about Optic Neuritis
Primary ICD-10-CM Codes for optic neuritis
Decision Criteria
clinical Criteria
- MRI showing right optic nerve enhancement
documentation Criteria
- Right eye pain exacerbated by movement
Applicable To
- Right eye optic neuritis
Excludes
- Ischemic optic neuropathy (H47.01)
Clinical Validation Requirements
- MRI showing right optic nerve enhancement
- RAPD right eye
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented clearly to avoid unspecified codes.
H46.12 - Acute retrobulbar neuritis, left eye
Use when optic neuritis is confirmed in the left eye with clinical validation.
Applicable To
- Left eye optic neuritis
Excludes
- Ischemic optic neuropathy (H47.01)
Clinical Validation Requirements
- MRI showing left optic nerve enhancement
- RAPD left eye
Coding Notes
Ensure laterality is documented clearly to avoid unspecified codes.
H46.0 - Optic papillitis
Use when optic neuritis presents with optic disc edema.
Applicable To
- Optic disc edema
Excludes
- Ischemic optic neuropathy (H47.01)
Clinical Validation Requirements
- Optic disc edema on fundoscopy
- RNFL thickening on OCT
Coding Notes
Document optic disc findings clearly to differentiate from ischemic causes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Multiple sclerosis
G35Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Ischemic optic neuropathy
H47.01Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Optic Neuritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H46.11.
Impact
Clinical: Ambiguity in treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always include laterality in clinical notes, Cross-check with imaging reports
Impact
Reimbursement: Potential denial of claims due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data.
Mitigation Strategy
Ensure laterality is documented in the physician's note to use specific codes.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Violation of coding sequencing rules., Data Quality: Inaccurate representation of the patient's condition.
Mitigation Strategy
Code G35 (MS) first, followed by the specific optic neuritis code.
Impact
Claims with unspecified codes when laterality is documented elsewhere.
Mitigation Strategy
Ensure laterality is documented in the physician's note.
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 Optic Neuritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Optic Neuritis
Use these documentation templates to ensure complete and accurate documentation for Optic Neuritis. These templates include all required elements for proper coding and billing.
Definite MS-Associated Optic Neuritis
Specialty: NeurologyRequired Elements
- Patient history
- Clinical examination
- MRI findings
- Serology results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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