ICD-10 Coding for Posterior Capsular Opacification(H26.41, H26.42, H26.499)
Complete ICD-10-CM coding and documentation guide for Posterior Capsular Opacification. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Posterior Capsular Opacification
H26.4Primary Range
Other secondary cataract
This range includes codes for secondary cataracts such as posterior capsular opacification.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H26.41 | Secondary cataract, right eye | Use when PCO is confirmed in the right eye with documented visual impairment. |
|
| H26.42 | Secondary cataract, left eye | Use when PCO is confirmed in the left eye with documented visual impairment. |
|
| H26.499 | Other secondary cataract, unspecified eye | Use when PCO is present but laterality is not documented. |
|
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 posterior capsular opacification
Essential facts and insights about Posterior Capsular Opacification
Primary ICD-10-CM Codes for posterior capsular opacification
Decision Criteria
clinical Criteria
- BCVA of 20/30 or worse due to PCO
Applicable To
- Posterior capsular opacification, right eye
Excludes
- Primary cataract
Clinical Validation Requirements
- Documented best corrected visual acuity (BCVA) of 20/30 or worse
- Retroillumination images showing opacification
- Impact on activities of daily living (ADLs)
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
H26.42 - Secondary cataract, left eye
Use when PCO is confirmed in the left eye with documented visual impairment.
Applicable To
- Posterior capsular opacification, left eye
Excludes
- Primary cataract
Clinical Validation Requirements
- Documented best corrected visual acuity (BCVA) of 20/30 or worse
- Retroillumination images showing opacification
- Impact on activities of daily living (ADLs)
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
H26.499 - Other secondary cataract, unspecified eye
Use when PCO is present but laterality is not documented.
Applicable To
- Posterior capsular opacification, unspecified eye
Excludes
- Primary cataract
Clinical Validation Requirements
- Documented visual impairment due to PCO without specified laterality
Coding Notes
Avoid using this code if laterality can be determined.
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 Posterior Capsular Opacification to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H26.41.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure contrast sensitivity testing is performed and documented., Include results in the patient's chart.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure laterality is documented and use H26.41 or H26.42 as appropriate.
Impact
Failure to use modifier -78 for procedures within the global period can result in audit flags.
Mitigation Strategy
Ensure modifier -78 is applied when necessary and document the clinical rationale.
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 Posterior Capsular Opacification, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Posterior Capsular Opacification
Use these documentation templates to ensure complete and accurate documentation for Posterior Capsular Opacification. These templates include all required elements for proper coding and billing.
PCO with visual impairment
Specialty: OphthalmologyRequired Elements
- Chief complaint
- BCVA
- Retroillumination findings
- Impact on ADLs
- Consent for procedure
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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