ICD-10 Coding for Cataract(H25.1, H26.33)
Complete ICD-10-CM coding and documentation guide for Cataract. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cataract
H25-H28Primary Range
Disorders of lens
This range includes all types of cataracts, including age-related, congenital, and secondary cataracts.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H25.1 | Age-related nuclear cataract | Use when the cataract is age-related and affects the nucleus of the lens. |
|
| H26.33 | Drug-induced cataract, bilateral | Use when cataracts are caused by drug use and affect both eyes. |
|
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 nuclear cataract
Essential facts and insights about Cataract
Primary ICD-10-CM Codes for cataract
Decision Criteria
clinical Criteria
- Presence of nuclear sclerosis and age-related changes
Applicable To
- Senile nuclear cataract
Excludes
- Traumatic cataract (H26.2-)
Clinical Validation Requirements
- Documented yellowing or brunescence of the lens nucleus
- Best-corrected visual acuity ≤20/50
Code-Specific Risks
- Incorrectly coding as unspecified cataract
Coding Notes
- Ensure laterality is specified to avoid unspecified codes.
H26.33 - Drug-induced cataract, bilateral
Use when cataracts are caused by drug use and affect both eyes.
Applicable To
- Cataract due to drug use
Excludes
- Age-related cataract (H25.-)
Clinical Validation Requirements
- Documented use of a drug known to cause cataracts
- Bilateral lens opacity
Coding Notes
Ensure the drug causing the cataract is documented and coded.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cataract to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.1.
Impact
Clinical: Inaccurate patient records, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document and code the drug causing the cataract.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always specify the affected eye(s) to use the correct laterality code.
Impact
Use of unspecified codes can lead to audits.
Mitigation Strategy
Ensure documentation specifies laterality and type.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cataract
Use these documentation templates to ensure complete and accurate documentation for Cataract. These templates include all required elements for proper coding and billing.
Age-related cataract in the left eye
Specialty: OphthalmologyRequired Elements
- Visual acuity
- Slit-lamp findings
- Functional impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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