ICD-10 Coding for Secondary Cataract(H26.491, H26.492, H26.493)
Complete ICD-10-CM coding and documentation guide for Secondary Cataract. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Secondary Cataract
H26.4-H26.49Primary Range
Secondary cataract codes
These codes are used to classify secondary cataracts, including those due to surgery or other causes.
Mechanical complication of intraocular lens
Used for complications related to intraocular lenses, often in conjunction with secondary cataract.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H26.491 | Secondary cataract, right eye | Use when the secondary cataract is confirmed in the right eye post-surgery. |
|
| H26.492 | Secondary cataract, left eye | Use when the secondary cataract is confirmed in the left eye post-surgery. |
|
| H26.493 | Secondary cataract, bilateral | Use when the secondary cataract is confirmed in both eyes post-surgery. |
|
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 secondary cataract
Essential facts and insights about Secondary Cataract
Primary ICD-10-CM Codes for secondary cataract
Decision Criteria
clinical Criteria
- Presence of posterior capsule opacification in the right eye
documentation Criteria
- Documented impact on activities of daily living
Applicable To
- Secondary cataract in the right eye post-surgery
Excludes
- Primary cataract (H25.-)
Clinical Validation Requirements
- Slit-lamp examination confirming posterior capsule opacification
- Documented ADL impairment due to glare or reduced vision
Code-Specific Risks
- Incorrect laterality documentation
- Missing functional impairment documentation
Coding Notes
- Ensure laterality is documented and ADL impact is noted.
H26.492 - Secondary cataract, left eye
Use when the secondary cataract is confirmed in the left eye post-surgery.
Applicable To
- Secondary cataract in the left eye post-surgery
Excludes
- Primary cataract (H25.-)
Clinical Validation Requirements
- Slit-lamp examination confirming posterior capsule opacification
- Documented ADL impairment due to glare or reduced vision
Coding Notes
Ensure laterality is documented and ADL impact is noted.
H26.493 - Secondary cataract, bilateral
Use when the secondary cataract is confirmed in both eyes post-surgery.
Applicable To
- Secondary cataract in both eyes post-surgery
Excludes
- Primary cataract (H25.-)
Clinical Validation Requirements
- Slit-lamp examination confirming posterior capsule opacification in both eyes
- Documented ADL impairment due to glare or reduced vision
Coding Notes
Ensure laterality is documented and ADL impact is noted.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Type 2 diabetes mellitus with cataract
E11.36Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Secondary Cataract to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H26.491.
Impact
Clinical: Leads to potential treatment errors., Regulatory: Non-compliance with coding standards., Financial: Claims may be rejected or require resubmission.
Mitigation Strategy
Always verify and document the affected eye(s)., Use templates that prompt for laterality.
Impact
Reimbursement: Claims may be denied or delayed due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Verify and document the affected eye(s) clearly in the medical record.
Impact
Reimbursement: May lead to claim denials if functional impact is not documented., Compliance: Failure to meet documentation standards., Data Quality: Incomplete patient care records.
Mitigation Strategy
Ensure functional impairment is documented in the patient's record.
Impact
Lack of documentation on how the cataract affects daily activities.
Mitigation Strategy
Use ADL questionnaires and document specific impairments.
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 Secondary Cataract, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Secondary Cataract
Use these documentation templates to ensure complete and accurate documentation for Secondary Cataract. These templates include all required elements for proper coding and billing.
Postoperative Secondary Cataract
Specialty: OphthalmologyRequired Elements
- ADL impairment
- Slit-lamp examination results
- Visual acuity measurements
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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