ICD-10 Coding for Wet Macular Degeneration(H35.3211, H35.3222)
Complete ICD-10-CM coding and documentation guide for Wet Macular Degeneration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Wet Macular Degeneration
H35.32Primary Range
Choroidal neovascularization
This range includes codes for wet macular degeneration, specifying laterality and activity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.3211 | Active choroidal neovascularization, right eye | Use when active CNV is confirmed in the right eye with imaging and clinical symptoms. |
|
| H35.3222 | Inactive choroidal neovascularization, left eye | Use when CNV is inactive in the left eye with no fluid on imaging. |
|
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 wet macular degeneration
Essential facts and insights about Wet Macular Degeneration
Primary ICD-10-CM Codes for wet macular degeneration
Decision Criteria
clinical Criteria
- Presence of subretinal fluid and CNV on imaging
Applicable To
- Active CNV with fluid
Excludes
- Dry AMD (H35.31xx)
Clinical Validation Requirements
- OCT showing subretinal fluid
- OCTA confirming CNV
- Visual acuity decline
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality and activity are documented clearly.
H35.3222 - Inactive choroidal neovascularization, left eye
Use when CNV is inactive in the left eye with no fluid on imaging.
Applicable To
- Inactive CNV without fluid
Excludes
- Active CNV (H35.321x)
Clinical Validation Requirements
- OCT showing no fluid
- Stable visual acuity
Coding Notes
Document stability and lack of fluid clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Visual impairment
H54.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Wet Macular Degeneration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.3211.
Impact
Clinical: Impacts treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the affected eye., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data.
Mitigation Strategy
Update to specific codes based on imaging findings.
Impact
High denial rates for unspecified CNV codes.
Mitigation Strategy
Use specific codes based on imaging results.
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 Wet Macular Degeneration, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Wet Macular Degeneration
Use these documentation templates to ensure complete and accurate documentation for Wet Macular Degeneration. These templates include all required elements for proper coding and billing.
Active CNV with Anti-VEGF Treatment
Specialty: OphthalmologyRequired Elements
- Diagnosis
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Wet Macular Degeneration? Ask your questions below.