ICD-10 Coding for Central Retinal Artery Occlusion(H34.11, H34.12, H34.13, H34.10)
Complete ICD-10-CM coding and documentation guide for Central Retinal Artery Occlusion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Central Retinal Artery Occlusion
H34.1Primary Range
Central retinal artery occlusion
This range includes all codes related to central retinal artery occlusion, specifying laterality and unspecified cases.
Branch retinal artery occlusion
This range is used for branch retinal artery occlusion, which must be differentiated from central occlusion.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H34.11 | Central retinal artery occlusion, right eye | Use when CRAO is confirmed in the right eye with specific clinical findings. |
|
| H34.12 | Central retinal artery occlusion, left eye | Use when CRAO is confirmed in the left eye with specific clinical findings. |
|
| H34.13 | Central retinal artery occlusion, bilateral | Use when CRAO is confirmed in both eyes with specific clinical findings. |
|
| H34.10 | Central retinal artery occlusion, unspecified eye | Use when CRAO is confirmed but laterality is not documented. |
|
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 central retinal artery occlusion
Essential facts and insights about Central Retinal Artery Occlusion
Primary ICD-10-CM Codes for central retinal artery occlusion
Decision Criteria
clinical Criteria
- Presence of cherry red spot and sudden vision loss
coding Criteria
- Document laterality to select correct subcode
Applicable To
- CRAO of the right eye
Excludes
- Branch retinal artery occlusion (H34.2)
Clinical Validation Requirements
- Sudden, painless monocular vision loss
- Cherry red spot on fundoscopy
- Retinal whitening/pallor
Code-Specific Risks
- Misclassification as branch retinal artery occlusion
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
H34.12 - Central retinal artery occlusion, left eye
Use when CRAO is confirmed in the left eye with specific clinical findings.
Applicable To
- CRAO of the left eye
Excludes
- Branch retinal artery occlusion (H34.2)
Clinical Validation Requirements
- Sudden, painless monocular vision loss
- Cherry red spot on fundoscopy
- Retinal whitening/pallor
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
H34.13 - Central retinal artery occlusion, bilateral
Use when CRAO is confirmed in both eyes with specific clinical findings.
Applicable To
- CRAO of both eyes
Excludes
- Branch retinal artery occlusion (H34.2)
Clinical Validation Requirements
- Sudden, painless vision loss in both eyes
- Cherry red spot on fundoscopy
- Retinal whitening/pallor
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
H34.10 - Central retinal artery occlusion, unspecified eye
Use when CRAO is confirmed but laterality is not documented.
Applicable To
- CRAO without specified laterality
Excludes
- Branch retinal artery occlusion (H34.2)
Clinical Validation Requirements
- Sudden, painless monocular vision loss
- Cherry red spot on fundoscopy
- Retinal whitening/pallor
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Branch retinal artery occlusion
H34.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Central Retinal Artery Occlusion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H34.11.
Impact
Clinical: May affect treatment decisions and patient outcomes., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of reimbursement for related conditions.
Mitigation Strategy
Thoroughly review patient history for comorbid conditions., Ensure all relevant conditions are documented and coded.
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment and affect reimbursement., Compliance: Misclassification can result in non-compliance with coding standards., Data Quality: Leads to inaccurate clinical data and affects patient care quality.
Mitigation Strategy
Ensure documentation specifies whether the occlusion is central or branch.
Impact
Reimbursement: Using unspecified codes can result in lower reimbursement rates., Compliance: Non-compliance with ICD-10 coding specificity requirements., Data Quality: Reduces the accuracy of clinical data and impacts treatment decisions.
Mitigation Strategy
Always document the affected eye to ensure correct subcode selection.
Impact
Failure to document laterality can lead to unspecified coding.
Mitigation Strategy
Implement a checklist to ensure laterality is documented in all cases.
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 Central Retinal Artery Occlusion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Central Retinal Artery Occlusion
Use these documentation templates to ensure complete and accurate documentation for Central Retinal Artery Occlusion. These templates include all required elements for proper coding and billing.
Acute CRAO in Emergency Department
Specialty: OphthalmologyRequired Elements
- Chief complaint
- History of present illness
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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