ICD-10 Coding for Bilateral Cataract(H25.2, H26.9)
Complete ICD-10-CM coding and documentation guide for Bilateral Cataract. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Cataract
H25-H26Primary Range
Cataract
This range includes all types of cataracts, including age-related and other specified types.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H25.2 | Age-related cataract, bilateral | Use when documentation specifies age-related cataracts affecting both eyes. |
|
| H26.9 | Unspecified cataract | Use when the type of cataract is not specified in the documentation. |
|
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 bilateral cataracts
Essential facts and insights about Bilateral Cataract
Primary ICD-10-CM Codes for bilateral cataract
Decision Criteria
clinical Criteria
- Patient presents with age-related changes in both eyes.
documentation Criteria
- Documentation must specify 'age-related' and 'bilateral'.
Applicable To
- Senile cataract, bilateral
- Nuclear sclerosis, bilateral
Clinical Validation Requirements
- Slit-lamp exam showing nuclear sclerosis ≥2+ in both eyes
- Patient age typically over 50 years
Code-Specific Risks
- Misclassification if laterality is not documented
- Incorrect use if cataract type is unspecified
Coding Notes
- Ensure documentation specifies 'age-related' and 'bilateral' to use this code.
H26.9 - Unspecified cataract
Use when the type of cataract is not specified in the documentation.
Excludes
- Age-related cataract (H25.2)
- Congenital cataract (Q12.0)
Clinical Validation Requirements
- Lack of specific type documentation
- General cataract diagnosis without further details
Coding Notes
Avoid using this code if specific cataract type can be documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of intraocular lens
Z96.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Cataract to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.2.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding guidelines, Financial: Potential claim denials
Mitigation Strategy
Always specify laterality in the diagnosis, Use templates to ensure completeness
Impact
Reimbursement: Potential denial or reduced payment due to lack of specificity., Compliance: Increased audit risk due to non-specific coding., Data Quality: Decreased data accuracy for clinical research and reporting.
Mitigation Strategy
Ensure documentation specifies 'age-related' and 'bilateral' to use H25.2.
Impact
Frequent use of unspecified codes like H26.9 can trigger audits.
Mitigation Strategy
Ensure documentation supports specific cataract types.
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 Bilateral Cataract, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Cataract
Use these documentation templates to ensure complete and accurate documentation for Bilateral Cataract. These templates include all required elements for proper coding and billing.
Age-related bilateral cataracts affecting ADLs
Specialty: OphthalmologyRequired Elements
- Patient age and cataract type
- Impact on ADLs
- Slit-lamp exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Bilateral Cataract? Ask your questions below.