ICD-10 Coding for Cataracts(H25.0, H26.1, H26.33)
Complete ICD-10-CM coding and documentation guide for Cataracts. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cataracts
H25-H26Primary Range
Cataract
This range includes all types of cataracts, including age-related, traumatic, and drug-induced.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H25.0 | Age-related nuclear cataract | Use when nuclear sclerosis is confirmed in patients over 50 with gradual vision loss. |
|
| H26.1 | Traumatic cataract | Use when cataract results directly from ocular trauma. |
|
| H26.33 | Drug-induced cataract, bilateral | Use when cataracts are caused by medication, affecting 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 cataracts
Essential facts and insights about Cataracts
Primary ICD-10-CM Codes for cataracts
Decision Criteria
clinical Criteria
- Patient age over 50 with nuclear sclerosis
Applicable To
- Nuclear sclerosis
Excludes
- Traumatic cataract (H26.1)
Clinical Validation Requirements
- Nuclear sclerosis on slit-lamp exam
- Gradual vision loss in patients >50 years
Code-Specific Risks
- Misclassification if not age-related
Coding Notes
- Ensure age-related etiology is documented.
H26.1 - Traumatic cataract
Use when cataract results directly from ocular trauma.
Applicable To
- Cataract due to trauma
Excludes
- Age-related cataract (H25.-)
Clinical Validation Requirements
- Documented ocular trauma history
- Visible lens disruption
Coding Notes
Ensure trauma is clearly documented.
H26.33 - Drug-induced cataract, bilateral
Use when cataracts are caused by medication, affecting both eyes.
Applicable To
- Cataract due to medication
Excludes
- Age-related cataract (H25.-)
Clinical Validation Requirements
- History of drug use known to cause cataracts
- Bilateral lens changes
Coding Notes
Document specific drug and adverse effect.
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 Cataracts to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.0.
Impact
Clinical: Inadequate assessment of visual impairment., Regulatory: Non-compliance with payer requirements., Financial: Potential claim denials.
Mitigation Strategy
Include glare testing in all cataract evaluations.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use specific H25.21-23 for Morgagnian type
Impact
Frequent omission leads to audit flags.
Mitigation Strategy
Standardize glare testing documentation in templates.
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 Cataracts, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cataracts
Use these documentation templates to ensure complete and accurate documentation for Cataracts. These templates include all required elements for proper coding and billing.
Cataract surgery evaluation
Specialty: OphthalmologyRequired Elements
- Chief complaint
- Best-corrected 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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