ICD-10 Coding for Choroidal Nevus(D31.31, D31.32, H35.8)
Complete ICD-10-CM coding and documentation guide for Choroidal Nevus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Choroidal Nevus
D31.3-D31.32Primary Range
Benign neoplasm of choroid
This range covers benign neoplasms of the choroid, including choroidal nevus, with specific codes for laterality.
Other specified retinal disorders
Used for complications such as subretinal fluid associated with choroidal nevus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D31.31 | Benign neoplasm of right choroid | Use when a benign choroidal nevus is identified in the right eye without complications. |
|
| D31.32 | Benign neoplasm of left choroid | Use when a benign choroidal nevus is identified in the left eye without complications. |
|
| H35.8 | Other specified retinal disorders | Use as a secondary code when subretinal fluid is present with a choroidal nevus. |
|
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 choroidal nevus
Essential facts and insights about Choroidal Nevus
Primary ICD-10-CM Codes for choroidal nevus
Decision Criteria
clinical Criteria
- Presence of a benign appearing nevus in the right choroid
Applicable To
- Choroidal nevus of right eye
Excludes
- Malignant melanoma of choroid (C69.41)
Clinical Validation Requirements
- Fundus photography showing nevus
- OCT confirming absence of subretinal fluid
Code-Specific Risks
- Incorrectly coding as malignant melanoma
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
D31.32 - Benign neoplasm of left choroid
Use when a benign choroidal nevus is identified in the left eye without complications.
Applicable To
- Choroidal nevus of left eye
Excludes
- Malignant melanoma of choroid (C69.41)
Clinical Validation Requirements
- Fundus photography showing nevus
- OCT confirming absence of subretinal fluid
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
H35.8 - Other specified retinal disorders
Use as a secondary code when subretinal fluid is present with a choroidal nevus.
Applicable To
- Subretinal fluid associated with choroidal nevus
Clinical Validation Requirements
- OCT showing subretinal fluid
Coding Notes
Document presence of subretinal fluid to justify use.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other specified retinal disorders
H35.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Malignant melanoma of choroid
C69.41Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Choroidal Nevus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D31.31.
Impact
Clinical: Inadequate monitoring of potential growth., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient detail.
Mitigation Strategy
Always measure and record the basal diameter and thickness.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always document and code the specific eye affected.
Impact
Reimbursement: Potential under-coding affecting DRG assignment., Compliance: Failure to fully capture the clinical picture., Data Quality: Incomplete patient data.
Mitigation Strategy
Ensure subretinal fluid is documented and coded with H35.8.
Impact
Using unspecified codes when laterality is documented.
Mitigation Strategy
Ensure laterality is always documented and coded.
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 Choroidal Nevus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Choroidal Nevus
Use these documentation templates to ensure complete and accurate documentation for Choroidal Nevus. These templates include all required elements for proper coding and billing.
Routine ophthalmology exam with choroidal nevus
Specialty: OphthalmologyRequired Elements
- Laterality
- Size and location of nevus
- Presence of drusen or subretinal fluid
- Stability over time
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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