ICD-10 Coding for Cataract Right Eye(H25.11)
Complete ICD-10-CM coding and documentation guide for Cataract Right Eye. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cataract Right Eye
H25.0-H25.9Primary Range
Age-related Cataract
This range includes various types of age-related cataracts, including nuclear, cortical, and posterior subcapsular cataracts.
Key Information: ICD-10 code for cataract right eye
Essential facts and insights about Cataract Right Eye
Primary ICD-10-CM Code for cataract right eye
Decision Criteria
clinical Criteria
- Nuclear sclerosis ≥2+ on slit lamp
documentation Criteria
- Patient-reported visual limitations affecting ADLs
Applicable To
- Nuclear sclerosis cataract in the right eye
Clinical Validation Requirements
- Slit lamp findings showing nuclear sclerosis ≥2+
- BCVA ≤20/40
- Glare testing results
Code-Specific Risks
- Incorrectly coding without specifying nuclear type
- Confusing with H25.09 (other incipient)
Coding Notes
- Ensure laterality is correctly documented and coded.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of intraocular lens
Z96.1Differential 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 Cataract Right Eye to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.11.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify right or left eye in documentation, Use RT/LT modifiers for procedures
Impact
Reimbursement: Claims may be denied due to lack of specificity., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data affecting patient records and statistics.
Mitigation Strategy
Ensure documentation specifies nuclear sclerosis and laterality as right eye.
Impact
Inadequate documentation of visual impairment and cataract type.
Mitigation Strategy
Include detailed patient-reported symptoms and clinical findings.
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 Cataract Right Eye, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cataract Right Eye
Use these documentation templates to ensure complete and accurate documentation for Cataract Right Eye. These templates include all required elements for proper coding and billing.
Pre-surgical assessment for cataract surgery
Specialty: OphthalmologyRequired Elements
- Patient-reported symptoms
- Visual acuity and glare testing
- Slit lamp examination findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Cataract Right Eye? Ask your questions below.