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Resource Ophthalmology Coding

An excellent resource for optometry billing and coding guide and cheat sheet for optometrists just starting out or for experienced ODs who want a thorough refresher.

Knowing the difference between routine and medical plans, what copays may be applicable to visits, or how deductibles will affect fees is crucial.

In this complete guide, you’ll learn the following:


 
An ophthalmic diagnostic test is commonly referred to as unilateral when each eye or side tested is paid separately and as bilateral when the payment encompasses the performance of the test on both eyes or sides.

Modifier 50
Do’s and Don’ts for Diagnostic Tests

  • Do use modifier 50 when performing bilateral tests only if the MPFSDB bilateral surgery indicator is 3.
  • Do use the RT and LT modifiers when performing bilateral tests only if the MPFSDB bilateral surgery indicator is 3.
  • Do use one of the above choices depending on your Medicare Administrative Contractor’s claim processing instructions.
  • Do not use modifier 50 with a procedure code that is described as bilateral, or unilateral or bilateral, in its CPT description.
  • Do not report a bilateral service on two lines of service by appending modifier 50 to the second line of service.
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The CPT description for OCT (92134) for the retina was given above in the discussion of “unilateral or bilateral.” It does contain the phrase “unilateral or bilateral,” with a bilateral surgery indicator of 2, and it is therefore billed only once regardless of whether one or both sides are tested. Do not use modifier 52 when only one side is tested. Caution is also warranted when billing fundus photography in lieu of OCT because age-related macular degeneration treatment is based on the results of OCT; thus, it is OCT, not fundus photography, for which there is medical necessity.

92250 Fundus photography with interpretation and report
Fundus photography has a bilateral surgery indicator of 2 and does not contain the designation “unilateral or bilateral” in the descriptor. Therefore, if only one eye is documented, then use of modifier 52 (reduced services) is appropriate.

CPT codes for ophthalmic and orbital ultrasound (76510 through 76513, 76529) do not have any descriptor designation for laterality. The bilateral surgery indicator for each one is 3; thus, each side can be coded separately, as long as there is medical necessity for testing each side

 
The most commonly used appropriate abbreviations for ophthalmology coding.

a.c. - Before meals ante cibum
AAG - Acute angle closure glaucoma
AC - Anterior chamber
ACC - Accommodative
ACG - Angle closure glaucoma
ACIOL - Anterior chamber IOL
ACT - Alternate cover test
AFGE - Air fluid gas exchange
AL - Axial length
ALK - Automated lamellar keratoplasty
ALT - Argon laser trabeculoplasty
AMD - Age-related macular degeneration
APCT - Alternate prism + cover test
APD - Afferent pupillary defect
Appl - Applanation tension
ARMD - Age related macular degeneration
ASC - Ambulatory surgical center
AT - Applanation tension
ATR - Against-the-rule astigmatism
BDR - Background diabetic retinopathy
b.i.d. - Twice a day bis in die
C + S - Culture and sensitivity
C/D - Cup-to-disc ratio
CA - Corneal abrasion
CACG - Chronic angle closure glaucoma
D - Diopter
D + N - Distance and near
D&V - Ductions and versions
F + F - Fix and follow
f/u - Follow-up
FA - Fluorescein angiography
FB - Foreign body
FH - Family history
FTFC - Full to finger counting
FTG - Full-time glasses
FTP - Full-time patch
GP - Gas permeable
GPC - Giant papillary conjunctivitis
GVF - Goldmann visual field
H - Hyperphoria
H + P - History and physical
h.s. - At bedtime hora somni
h/o - History of
HA - Headache
ICCE - Intracapsular cataract extraction
ICG - Indocyanine green angiography
IOL - Intraocular lens
IOP - Intraocular pressure
J J1 J2 - Jaeger notation/size of type for near vision
JODM - Juvenile onset diabetes mellitus
KCS - Keratoconjunctivitis sicca
K-reading - Measurement of corneal curvature with a keratometer
LASIK - Laser in situ keratomileusis
LD - Lattice degeneration
LL - Lower lid
LLL - Left lower lid
LLR - Left lateral rectus
LMR - Left medial rectus
LP - Light perception
LP+P - Light perception and projection
LT - Left
MG - Myasthenia gravis
MI - Myocardial infarction; heart attack
MR - Manifest refraction
MS - Multiple sclerosis
N - Near
N + V - Nausea and vomiting
n.p.o. - Nothing by mouth nil per Os
NI - No improvement
NKA - No known allergies
NKDA - No known drug allergies
NI - Normal
NLD - Nasolacrimal duct
NLP - No light perception
NML - Normal
NPDR - Non-proliferative diabetic retinopathy
NR - Non-reactive
NS - Nuclear sclerosis
NVM - Neovascular membrane
OAG - Open angle glaucoma
OHT - Ocular hypertensive
OD - right eye oculus dexter
OS - Left eye oculus sinister
OU - Both eyes oculus uterque
p.c. - After meals
p.o. - By mouth
p.p. - After eating
PACT - Prism + alternate cover test
PAM - Potential acuity meter
PC - Posterior capsule
PCIOL - Posterior chamber IOL
PD - Prism diopter
PDR - Proliferative diabetic retinopathy
ph - Pin hole
PI - Peripheral iridectomy/iridotomy
PK - Penetrating keratoplasty
pl - Plano lens
PMH - Past medical history
PMMA - Polymethylmethacrylate
p/o - Postoperatively
POAG - Primary open angle glaucoma
PPL - Pars plana lensectomy
PPV - Pars plana vitrectomy
PRK - Photorefractive keratectomy
PRP - Pan retinal photocoagulation
PSC - Posterior subcapsular cataract
q.a.m. - Every day before noon
q.d. - Every day
q.h. - Every hour
q.h.s. - At bedtime
q.i.d. - 4 times a day
q.n. - Every night
q.o.d. - Every other day
q.p.m. - Every day after noon
RA - Rheumatoid arthritis
RAPD - Relative afferent papillary defect
RD - Retinal detachment
REF - Refraction
REM - Rapid eye movement
RET - Retinoscopy
RGP - Rigid gas permeable
RIO - Right inferior oblique
RIR - Right inferior rectus
RK - Radial keratotomy
RLL - Right lower lid
RLR - Right lateral rectus
RMR - Right medial rectus
ROP - Retinopathy of prematurity
ROS - Review of systems
RP - Retinitis pigmentosa
R&R - Recess and resect
RSO - Right superior oblique
RSR - Right superior rectus
RT - Right eye
RTC - Return to clinic
RUL - Right upper eyelid
RX - Treatment – glasses, medicine, etc
RXT - Right exotropia
SCC - Squamous cell carcinoma
SCL - Soft contact lens
SO - Superior oblique
SOB - Short of breath
SCODI - Scanning computerized ophthalmic diagnostic imaging
SPH - Sphere
SPK - Superficial punctate keratitis
SR - Superior rectus
SRNV - Subretinal neovascular membrane
stat. - Immediately
Sub.q. - Subcutaneous under the skin
Sx - Symptoms
T - Tension
TA - Tension by applanation
TBT - Tear break-up time
TM - Trabecular meshwork
Trab - Trabeculectomy
TRD - Traction retinal detachment
Tx - Treatment
ung - Ointment
VA - Visual acuity
VF - Visual field
Vit - Vitreous
x - Exophoria at distance
XT - Exotropia at distance
YAG - Yttrium-aluminum-garnet laser
 
Coding Glaucoma

Assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, which eye is affected, and the glaucoma stage.

Bilateral glaucoma with same type and stage
When both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.

If both eyes are documented as being the same type and stage, and the classification does not provide a code for bilateral glaucoma i.e. subcategories H40.10, and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage.

Bilateral glaucoma stage of different types or stages
For bilateral glaucoma and each eye is documented as having a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma.

Bilateral glaucoma and each eye is documented as having a different type, and the classification does not distinguish laterality (i.e., subcategories H40.10, and
H40.20), assign one code for each type of glaucoma with the appropriate seventh character for the stage.

Bilateral glaucoma and each eye is documented as having the same type, but different stage, and the classification does not distinguish laterality (i.e.,
subcategories H40.10 and H40.20), assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye.

A patient admitted with glaucoma and stage evolves during the admission, assign the code for highest stage documented.

Indeterminate stage glaucoma
Assignment of the seventh character “4” for “indeterminate stage” should be based on the clinical documentation. The seventh character “4” is used for glaucomas whose stage cannot be clinically determined. This seventh character should not be confused with the seventh character “0”, unspecified, which
should be assigned when there is no documentation regarding the stage of the glaucoma.



Glaucoma is a group of diseases that can damage the eye’s optic nerve and is the leading cause of blindness in the United States. The codes for glaucoma are located in categories H40-H42 in ICD-10-CM and are broken down by type, laterality (in some cases), and stage (in some cases):
  • Preglaucoma, unspecified (H40.00- through H40.06-): Also called glaucoma suspect. A person with one or more risk factors which may lead to glaucoma, but currently does not have definite glaucomatous optic nerve damage or visual field defect. The codes have choices for right, left, bilateral, and unspecified.
  • Primary open angle glaucoma (H40.11-): This is the most common form of glaucoma that occurs mainly in people over the age of 50. There are no symptoms with primary open-angle glaucoma. It occurs when the eye’s drainage canals become clogged over time, causing the intraocular pressure (IOP) to rise.
  • Low-tension glaucoma (H40.12-): Also called normal-pressure glaucoma. The optic nerve is damaged even though the pressure in the eye is not very high. The codes have choices for right, left, bilateral, and unspecified.
  • Pigmentary glaucoma (H40.13-): This type of glaucoma occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, slowing fluid drainage. The codes have choices for right, left, bilateral, and unspecified.
  • Capsular glaucoma with pseudoexfoliation of lens (H40.14-): Deposits in all parts of the eye, including the lens capsule, of a material derived from basement membranes, eventually clogging the trabecular meshwork, obstructing the outflow of aqueous humor from the eye, causing glaucoma. The codes have choices for right, left, bilateral, and unspecified.
  • Residual stage of open-angle glaucoma (H40.15-): The codes have choices for right, left, bilateral, and unspecified.
  • Acute angle-closure glaucoma (H40.21-): This type of glaucoma is caused by a blocked drainage canals, which results in sudden, severe, and painful rise in intraocular pressure. The codes have choices for right, left, bilateral, and unspecified.
  • Chronic angle-closure glaucoma (H40.22-): This form of angle-closure occurs over time and not suddenly. The codes have choices for right, left, bilateral, and unspecified.
  • Intermittent angle-closure glaucoma (H40.23-): A patient with intermittent episodes of angle closure that resolve between attacks. The codes have choices for right, left, bilateral, and unspecified.
  • Residual stage of angle-closure glaucoma (H40.24-): The codes have choices for right, left, bilateral, and unspecified.
  • Glaucoma secondary to eye trauma (H40.3-): There is an instructional note indicating to code also the underlying condition. The codes have choices for right, left, bilateral, and unspecified.
  • Glaucoma secondary to eye inflammation (H40.4-): There is an instructional note indicating to code also the underlying condition. The codes have choices for right, left, bilateral, and unspecified.
  • Glaucoma secondary to other eye disorders (H40.5-): There is an instructional note indicating to code also the underlying condition. The codes have choices for right, left, bilateral, and unspecified.
  • Glaucoma secondary to drugs (H40.6-): There is an instructional note to use an additional code for adverse effect, if applicable, to identify the drug (T36-T50 with fifth or sixth character 5).
  • Other glaucoma (H40.:cool:: Includes glaucoma with increased episcleral venous pressure, hypersecretive glaucoma, and aqueous misdirection. The codes have choices for right, left, bilateral, and unspecified.
  • Glaucoma in diseases classified elsewhere (H42): There is an instructional note that states to code first the underlying condition, such as:
  • Amyloidosis (E85.-)
  • Aniridia (Q13.1)
  • Lowe’s syndrome (E72.03)
  • Reiger’s anomaly (Q13.81)
  • Specified metabolic disorder (E70-E88)
Some subcategories in the glaucoma code block require 7th character extenders to indicate the stage of glaucoma. The 7th character extenders are as follows:
0Stage unspecified
1Mild stage
2Moderate stage
3Severe stage
4Indeterminate stage
The 7th character extenders are applicable to the following subcategories:
H40.10-, H40.11-, H40.12-, H40.13-, H40.14-, H40.20-, H40.22-, H40.3-, H40.4-, H40.5-, and H40.6-
Some codes will require the use of the dummy placeholder X.
 
Blindness

Blindness and low vision are categorized by visual acuity. If the provider documents the patient has blindness or low vision in both eyes, but does not document the visual impairment category, H54.3 Unqualified visual loss, both eyes is reported. For blindness or low vision documented for a single eye without further specification, H54.6- Unqualified visual loss, one eye is reported. When a provider does not document whether one or both eyes are affected, H54.7 Unspecified visual loss must be reported.

If blindness or low vision of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. If blindness or low vision in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye. If blindness or visual loss is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.

Documentation will need to include:

  • Type
  • Stage (category)
  • Laterality
Categories are divided between mild or no visual impairment, moderate, severe and blindness.

CategoryWorse than:Equal to or better than:
Mild or no visual impairment
0
6/18
3/10 (0.3)
20/70
Moderate visual impairment
1
6/18
3/10 (0.3)
20/70
6/60
1/10 (0.1)
20/200
Severe visual impairment
2
6/60
1/10 (0.1)
20/200
3/60
1/20 (0.5)
20/400
Blindness
3
3/60
1/20 (0.5)
20/400
1/60*
1/50 (0.02)
5/300 (20/1200)
Blindness
4
1/60*
1/50 (0.02)
5/300 (20/1200)
Light perception
Blindness
5
No light perceptionNo light perception
9Undetermined or unspecifiedUndetermined or unspecified

 
Choosing between E/M & Eye visit codes.

Most non-Medicare payers require a medical diagnosis for E&M codes and a refractive diagnosis for Eye codes.



Eye Visit Codes​

The Eye visit codes for both new and established patients have two classifications: comprehensive and intermediate. The Academy has developed guidance on how to appropriately document for both intermediate and comprehensive Eye visit code services outlined in the chart below.

Documentation ComponentEye Visit Code Comprehensive Exam ComponentsEye Visit Code Intermediate Exam Components
CPT codes 92004 and 92014CPT codes 92002 and 92012
History
  • History (not defined)
  • General medical observation (not defined)
  • Chief Complaint
  • History (not defined)
  • General medical observation (not defined)
  • Chief Complaint
ExamExam: all 12 elements of the examExam: 3 or more, but less than 12 elements of the exam medically necessary to perform
Impression/PlanInitiation or continuation of diagnostic and treatment programsInitiation or continuation of diagnostic and treatment programs

Examination Elements
1. Visual acuity
  • Does not include the determination of refractive error CPT code 92015 Determination of refractive state
2. Gross or confrontation visual fields
  • Must be performed in the lane in order to count; automated perimetry does not substitute as an element of the exam
3. Extraocular motility
  • Includes alignment and primary gaze
4. Conjunctiva
  • Bulbar and palpebral
5. Ocular adnexa
  • Lids, lacrimal gland, lacrimal drainage, orbits and preauricular nodes
6. Pupil and iris
  • Size, shape, direct and consensual reactions and morphology
7. Cornea — slit-lamp exam
  • Tear film, epithelium, stroma and endothelium
8. Anterior chamber — slit-lamp exam
  • Depth, cells and flare
9. Lens
  • Clarity, anterior capsule, posterior capsule, cortex and nucleus
10. Intraocular pressure
11. Optic nerve/discs
  • Cup-to-disc ratio, appearance and nerve fiber layer
12. Retina and vessels
  • Examination through dilated pupils, unless contraindicated

The history and general medical observations requirements are not defined. Chief complaint, the reason why the patient is there, is always required. Eye visit codes always require the initiation or continuation of diagnostic and treatment programs and may include, but are not limited to: prescribing medication, arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services. Essentially you need to state what the problem is and what you recommend doing about it.

What about dilation? The Comprehensive Eye code exam often includes — as indicated — biomicroscopy, exam with cycloplegia or mydriasis and tonometry. If dilation is not performed, documentation must clearly state why. Dilation is not a requirement for E/M codes.

92004: Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits.

92014: Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits.

What is a comprehensive exam and evaluation? In brief, it is a general evaluation of the complete visual system. To bill for a comprehensive Eye visit code, you also must initiate or continue a diagnostic and/or treatment plan (see checklist below).

Comprehensive or intermediate exam? The comprehensive Eye visit codes (92004 and 92014) require all 12 elements of the examination (see checklist below), whereas you can submit the intermediate codes (92002 and 92012) if you’ve performed at least three, but fewer than 12, of them.

There are nine specific situations that you need to be aware of when you should bill an E/M code in place of an eye visit code. Billing for eye visit codes during these situations could lead to a denial and/or patient responsibility.

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Systemic diseases such as Lupus, multiple sclerosis, and rheumatoid arthritis are all covered with E/M codes but not always covered with Eye visit codes. Some payers have frequency edits, or limits on how often you can bill eye visit codes in a year. Payers do not have frequency edits for E/M codes. Eye visit code use may be restricted by some commercial payers to routine/annual exam or vision plans. These same payers may also only permit use of E/M codes for medical diagnoses.


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Opthalmology resource links:

Decision Trees
Quick Reference Guides
 
Long-Term Drugs for Ophthalmology.

Patients taking Plaquenil (hydroxychloroquine, Sanofi-Aventis) on a long-term basis

Coders should use Z79.899—Other Long Term (Current) Drug Therapy as Plaquenil does not have its own specific category in ICD-10 LTD.

 
Z Codes
Z01.020 = Encounter for examination of eyes and vision following failed vision screening without abnormal findings.
Z01.021 = Encounter for examination of eyes and vision following failed vision screening with abnormal findings.

 
Diagnostic Tests
  • Do use modifier 50 when performing bilateral tests only if the MPFSDB bilateral surgery indicator is 3.
  • Do use the RT and LT modifiers when performing bilateral tests only if the MPFSDB bilateral surgery indicator is 3.
  • Do use one of the above choices depending on your Medicare Administrative Contractor’s claim processing instructions.
  • Do not use modifier 50 with a procedure code that is described as bilateral, or unilateral or bilateral, in its CPT description.
  • Do not report a bilateral service on two lines of service by appending modifier 50 to the second line of service.

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Injectable Drugs
General Guidelines
  • Use the appropriate Healthcare Common Procedure Coding System (HCPCS) based on code descriptor.
  • Not Otherwise Classified (NOC) codes should only be reported for those drugs that do not have a valid HCPCS code which describes the drug being administered.
  • Remarks are required to include dosage, name of drug, and route of administration.
  • You cannot bill for drugs that can be self-administered. The injection must be administered by physician.
  • If there is no expense to the physician for the drug, don’t bill for it.
  • Units of drugs must be accurately reported in terms of dosage specified in Health Care Procedure Code System (HCPCS) descriptor.
  • Do not bill units based on the way the drug is packaged, stored, or stocked.
  • Do not bill for the full amount of a drug when it has been split between two or more patients. Only bill for the amount given to each patient.
  • When billing a compounded drug, use HCPCS code J3490 and list each drug and its dosage in the descriptor field. Reference: OIG report April 2014.
  • Review the CMS ASP Drug Pricing Files for Medicare reimbursement.
  • When billing injections, always include the HCPCS drug code, even when no payment from the payer is required.
Single-Use Vials
Whether there is waste or not, submit the number of units assigned to the drug. For example:
Multiple Use Vials
Insurance companies will only pay for the amount administered to the patient and will not pay for any discarded amounts of the drug. See "Reporting Units of Drugs – Examples" section below. Read this article on getting reimbursements for multi-use vials.
Botulinum Toxins
  • For Medicare Part B patients, payment policy allows for only one injection code per side of the body regardless of the number of needle passes made into the site.
  • Proper documentation of complex or multiple injection sites can support and warrant additional reimbursement with some commercial payers while others pay one amount regardless of the number of injections.
  • Chart documentation should include:
    The number of injections
    The injection sites
    Units injected at each site
    Amount of medication wasted
Reporting Units of Drugs – Examples
Reminder: Documentation in the patient’s medical record must reflect the drug and dosage.
Example 1: HCPCS description of drug is 6 mg
6 mg are administered = 1 unit is billed

Example 2: HCPCS description of drug is 50 mg
200 mg are administered = 4 units are billed

Example 3: HCPCS description of drug is 1 mg
10 mg vial of drug is administered = 10 units are billed

Example 4: When billing a NOC drug
Submit 1 for the units. In Box 19 of the CMS 1500 form or electronic equivalent indicate the exact name of the drug and the dosage.
Drug Wastage
  • If the remainder of a vial must be discarded after being administered, insurance will cover the amount discarded as well as the amount administered.
  • The amount ordered, administered, and the amount discarded must be documented in the medical record. The date and time of administration should also be included.
  • The amount documented as wastage shall not be used on another patient, nor billed again to Medicare or other payer.
  • Reminder: payment for discarded drugs only applies to single use vials.
  • Modifier –JW identifies unused/wasted drug for single dose vials.
  • Effective Jan. 1, 2017 mandatory use of modifier -JW for Medicare Part B claims demonstrating units wasted
    Example:
    Triesence 40 units (J3300 Injection, triamcinolone acetonide, preservative free, 1 mg)
    J3300 4 units
    J3300 -JW 36 units

  • Example:
    Visudyne 150 units (J3396 Injection, verteporfin, 0.1 mg)
    J3396 63 units
    J3396 -JW 87 units

  • Other drugs document “any residual medication discarded”
Checklist/Guide for Coding Injections
  • CPT 67028, eye modifier appended (-RT or-LT)
  • Bilateral injections billed with a -50 modifier per payer guidelines. (Medicare Part B claims billed with 67028-50 on one line, fees doubled and 1 unit.)
  • HCPCS J-code for medication
  • Appropriate units administered (i.e., EYLEA 2 units)
  • HCPCS J-code on a second line for wasted medication, if appropriate
  • -JW modifier appended
  • Medically necessary ICD-10 code appropriately linked to 67028 and J-Code (s)
  • On the CMS-1500 claim form in item
  • 24a or EDI loop 2410: 11-digit NDC code in 5-4-2 format, proceeded by “N4” qualifier
  • 19 or EDI equivalent: Description of medication and dosage per insurance guidelines (e.g. Avastin)
Correct Coding for Commonly Injected Drugs
Local coverage determination policies can be found at www.aao.org/lcds.
Table of Common Drugs
Use this table as a reference to help you learn more about the HCPCS office, HCPCS facility, description and units for commonly injectable drugs.
National Drug Code
The National Drug Code is a unique 10-digit, three-segment number. It is a universal product identifier for human drugs in the United States. The code is present on all nonprescription (over-the-counter) and prescription medication packages and inserts in the United States.
Listing Your National Drug Code (NDC) Number Correctly on Claims
Many NDC numbers listed on drug packaging are in 10 digit format. The NDC number is essential for proper claim processing when submitting claims for drugs used. However, to be recognized by payers, it must be formatted into an 11 digit 5-4-2 sequence. This requires a zero to be placed in a specific position to meet the 5-4-2 format requirement. As not all NDC numbers are set up the same, the table below provides examples of appropriate position of the zero based on the three segment numbers listed on the packaging.

While many practice management systems automatically remove the hyphens, be sure they are excluded from submission on the claim.
 
Cataracts.

The codes for cataracts are located in categories H25 and H26 in ICD-10-CM. Some of the descriptors are different for cataracts. Instead of senile cataract, ICD-10-CM uses the verbiage age-related. Instead of hypermature cataracts, ICD-10-CM uses the verbiage Morgagnian. The descriptor pre-senile has been removed and ICD-10-CM uses only infantile and juvenile. The codes for cataracts are broken down by type and laterality:
Age-related incipient cataract — H25.0- subcategory:
  • Cortical age-related cataract (H25.01-): The most common senile cataract; white, wedge-like opacities are like spokes around the periphery of the cortex. The codes have choices for right, left, bilateral, and unspecified.
  • Anterior subcapsular polar age-related cataract (H25.03-): Cataract at the center of the anterior pole of the lens. The codes have choices for right, left, bilateral, and unspecified.
  • Posterior subcapsular polar age-related cataract (H25.04-): Cataract at the center of the posterior pole of the lens. The codes have choices for right, left, bilateral, and unspecified
  • Other age-related incipient cataract (H25.09-): These include coronary age-related cataracts, punctate age-related cataracts, and water clefts. The codes have choices for right, left, bilateral, and unspecified.
  • Age-related nuclear cataract (H25.1-): Cataracts in which the opacity is in the central nucleus of the eye. The codes have choices for right, left, bilateral, and unspecified.
  • Age-related cataract, Morgagnian type (H25.2-): This is a mature cataract in which the cortex has liquefied and the nucleus moves freely within the lens. The codes have choices for right, left, bilateral, and unspecified.
  • Combined forms of age-related cataract (H25.81-): The codes have choices for right, left, bilateral, and unspecified.
  • Other age-related cataract (H25.89)
  • Infantile and juvenile cataract — H26.0- subcategory:
  • Infantile and juvenile cortical, lamellar, or zonular cataract (H26.01-): Either cortical (defined above) and/or lamellar/zonal (cataract affecting only certain layers between the cortex and nucleus of the lens. The codes have choices for right, left, bilateral, and unspecified.
  • Infantile and juvenile nuclear cataract (H26.03-): The codes have choices for right, left, bilateral, and unspecified.
  • Anterior subcapsular polar infantile and juvenile cataract (H26.04-): The codes have choices for right, left, bilateral, and unspecified.
  • Posterior subcapsular polar infantile and juvenile cataract (H26.05-): The codes have choices for right, left, bilateral, and unspecified.
  • Combined forms of infantile and juvenile cataract (H26.06-): The codes have choices for right, left, bilateral, and unspecified.
  • Traumatic cataract — H26.1- subcategory: Cataracts due to injury to the eye.
  • Localized traumatic opacities (H26.11-): The codes have choices for right, left, bilateral, and unspecified.
  • Partially resolved traumatic cataract (H26.12-): The codes have choices for right, left, bilateral, and unspecified.
  • Total traumatic cataract (H26.13-): The codes have choices for right, left, bilateral, and unspecified.
  • Complicated cataract — H26.2- subcategory:
  • Cataract with neovascularization (H26.21-): There is an instructional note that states to code also the associated condition, such as chronic iridocyclitis (H20.1-). The codes have choices for right, left, bilateral, and unspecified.
  • Cataract secondary to ocular disorders (H26.22-): There is an instructional note that states to code also the associated ocular disorder. The codes have choices for right, left, bilateral, and unspecified.
  • Glaucomatous flecks (subcapsular) (H26.23-): Spots on the lens of the eye (also called glaukimflecken). The codes have choices for right, left, bilateral, and unspecified.
  • Drug-induced cataract (H26.3-): There is an instructional note that states to use an additional code for the adverse effect, if applicable, to identify the drug. The codes have choices for right, left, bilateral, and unspecified.
  • Secondary cataract — H26.4- subcategory:
  • Soemmering’s ring (H26.41-): Doughnut-shaped remnant of the lens behind the pupil, occurring after cataract surgery or secondary to traumas as a result of contact between the anterior capsule and the posterior capsule. The codes have choices for right, left, bilateral, and unspecified.
  • Other secondary cataract (H26.49-): The codes have choices for right, left, bilateral, and unspecified.
  • Congenital cataract (Q12.0)
 
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