ICD-10 Coding for Bilateral Cataracts(H25.03, H26.33)
Complete ICD-10-CM coding and documentation guide for Bilateral Cataracts. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Cataracts
H25-H26Primary Range
Cataract
This range includes all types of cataracts, including age-related, drug-induced, and traumatic cataracts, which are relevant for bilateral 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 |
|---|---|---|---|
| H25.03 | Age-related nuclear cataract, bilateral | Use when documenting bilateral age-related nuclear cataracts with appropriate clinical findings. |
|
| H26.33 | Drug-induced cataract, bilateral | Use when cataracts are linked to drug use, such as long-term steroid use. |
|
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 Cataracts
Primary ICD-10-CM Codes for cataracts bilateral
Decision Criteria
clinical Criteria
- Presence of bilateral nuclear cataracts with significant visual impairment.
Applicable To
- Bilateral age-related nuclear cataracts
Excludes
- Diabetic cataract (E11.36)
Clinical Validation Requirements
- LOCS III grading ≥3.0
- Glare testing ≥5.0 log units
- BCVA ≤20/40 OU
Code-Specific Risks
- Ensure bilateral status is documented; otherwise, use unilateral codes.
Coding Notes
- Ensure to update the code from bilateral to unilateral after the first eye surgery.
H26.33 - Drug-induced cataract, bilateral
Use when cataracts are linked to drug use, such as long-term steroid use.
Applicable To
- Bilateral cataracts due to drug use
Excludes
- Age-related cataract (H25.-)
Clinical Validation Requirements
- Medication list showing ≥1 year of glucocorticoids
- Absence of other risk factors
Coding Notes
Document the specific drug and duration of use.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Cataract extraction status
Z98.41Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Cataracts to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.03.
Impact
Clinical: Misrepresents patient's current clinical status., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Review and update codes post-surgery.
Impact
Reimbursement: May lead to claim denials or reduced payments., Compliance: Non-compliance with specificity requirements., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use specific bilateral codes like H25.03 or H26.33 based on etiology.
Impact
Incorrect use of -50 modifier for bilateral procedures.
Mitigation Strategy
Use RT/LT modifiers as per CMS guidelines.
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 Cataracts, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Cataracts
Use these documentation templates to ensure complete and accurate documentation for Bilateral Cataracts. These templates include all required elements for proper coding and billing.
Bilateral Cataract Surgery
Specialty: OphthalmologyRequired Elements
- Visual acuity measurements
- Slit lamp findings
- Functional impact on ADLs
- Surgical plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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