ICD-10 Coding for Cystoid Macular Edema(H35.351, H59.031)
Complete ICD-10-CM coding and documentation guide for Cystoid Macular Edema. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cystoid Macular Edema
H35.35-Primary Range
Cystoid macular degeneration
Primary range for non-postoperative cystoid macular edema.
Cystoid macular edema following cataract surgery
Used for CME that occurs post-cataract surgery.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.351 | Cystoid macular degeneration, right eye | Use when CME is diagnosed in the right eye without a surgical cause. |
|
| H59.031 | Cystoid macular edema following cataract surgery, right eye | Use when CME is diagnosed following cataract surgery in the right eye. |
|
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 cystoid macular edema
Essential facts and insights about Cystoid Macular Edema
Primary ICD-10-CM Codes for cystoid macular edema
Decision Criteria
clinical Criteria
- CME confirmed by OCT and fluorescein angiography
coding Criteria
- No recent cataract surgery
Applicable To
- Cystoid macular edema, right eye
Excludes
- Cystoid macular edema following cataract surgery (H59.031)
Clinical Validation Requirements
- OCT showing cystoid spaces and retinal thickness >300μm
- Fluorescein angiography confirming petaloid leakage
Code-Specific Risks
- Incorrectly using for post-cataract CME
Coding Notes
- Ensure documentation specifies non-surgical etiology.
H59.031 - Cystoid macular edema following cataract surgery, right eye
Use when CME is diagnosed following cataract surgery in the right eye.
Applicable To
- CME post-cataract surgery, right eye
Excludes
- Cystoid macular degeneration (H35.351)
Clinical Validation Requirements
- CME onset within 4-12 weeks post-cataract surgery
- OCT showing subfoveal fluid and intraretinal cysts
Coding Notes
Document cataract surgery date and CME onset.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E11.3511Differential 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 Cystoid Macular Edema to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.351.
Impact
Clinical: Ambiguity in treatment plans., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential claim rejections.
Mitigation Strategy
Always document which eye is affected., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use H59.031 for CME following cataract surgery.
Impact
Using H35.35- instead of H59.03- for post-cataract CME.
Mitigation Strategy
Verify surgical history and document appropriately.
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 Cystoid Macular Edema, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cystoid Macular Edema
Use these documentation templates to ensure complete and accurate documentation for Cystoid Macular Edema. These templates include all required elements for proper coding and billing.
CME post-cataract surgery
Specialty: OphthalmologyRequired Elements
- Patient history
- Surgical details
- OCT findings
- Fluorescein angiography results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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