ICD-10 Coding for Age-Related Macular Degeneration(H35.31x1, H35.31x3, H35.32x2)
Complete ICD-10-CM coding and documentation guide for Age-Related Macular Degeneration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Age-Related Macular Degeneration
H35.31-H35.32Primary Range
ICD-10 codes for age-related macular degeneration
These codes cover both dry and wet forms of age-related macular degeneration, including laterality and staging.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.31x1 | Early dry age-related macular degeneration | Use when early stage dry AMD is diagnosed with small drusen present. |
|
| H35.31x3 | Advanced dry AMD with geographic atrophy | Use when advanced dry AMD is diagnosed with geographic atrophy involving the foveal center. |
|
| H35.32x2 | Wet AMD left eye | Use when wet AMD is diagnosed in the left eye with confirmed CNV. |
|
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 age-related macular degeneration
Essential facts and insights about Age-Related Macular Degeneration
Primary ICD-10-CM Codes for age related macular degeneration
Decision Criteria
clinical Criteria
- Presence of small drusen without pigment changes
Applicable To
- Early stage dry AMD with small drusen
Excludes
- Wet AMD
Clinical Validation Requirements
- Multiple small drusen (<63μm) without pigment abnormalities
Code-Specific Risks
- Misclassification if drusen size is not documented
Coding Notes
- Ensure documentation specifies drusen size and absence of pigment abnormalities.
H35.31x3 - Advanced dry AMD with geographic atrophy
Use when advanced dry AMD is diagnosed with geographic atrophy involving the foveal center.
Applicable To
- Advanced stage dry AMD with geographic atrophy involving foveal center
Excludes
- Wet AMD
Clinical Validation Requirements
- Geographic atrophy involving foveal center
Coding Notes
Document geographic atrophy and foveal involvement explicitly.
H35.32x2 - Wet AMD left eye
Use when wet AMD is diagnosed in the left eye with confirmed CNV.
Applicable To
- Wet AMD with subretinal hemorrhage or fluid
Excludes
- Dry AMD
Clinical Validation Requirements
- Subretinal hemorrhage/fluid on OCT + CNV confirmed by angiography
Coding Notes
Ensure documentation includes OCT and angiography findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Age-Related Macular Degeneration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.31x1.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document laterality for AMD, Use templates to ensure completeness
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Require explicit documentation of GA presence and foveal involvement.
Impact
Missing details on drusen size or GA involvement.
Mitigation Strategy
Use structured templates to ensure all required details are documented.
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 Age-Related Macular Degeneration, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Age-Related Macular Degeneration
Use these documentation templates to ensure complete and accurate documentation for Age-Related Macular Degeneration. These templates include all required elements for proper coding and billing.
Ophthalmology Progress Note
Specialty: OphthalmologyRequired Elements
- Assessment of AMD stage and laterality
- OCT findings
- Angiography results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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