ICD-10 Coding for Dry Macular Degeneration(H35.3111, H35.3132)
Complete ICD-10-CM coding and documentation guide for Dry Macular Degeneration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dry Macular Degeneration
H35.31Primary Range
Nonexudative age-related macular degeneration
This range covers all stages and laterality of dry AMD, which is the primary focus for coding this condition.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.3111 | Nonexudative age-related macular degeneration, right eye, early stage | Use when early stage dry AMD is diagnosed in the right eye with specific findings. |
|
| H35.3132 | Nonexudative age-related macular degeneration, bilateral, intermediate stage | Use when intermediate stage dry AMD is diagnosed bilaterally with specific findings. |
|
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 dry macular degeneration
Essential facts and insights about Dry Macular Degeneration
Primary ICD-10-CM Codes for dry macular degeneration
Decision Criteria
clinical Criteria
- Documented presence of small drusen or pigmentary changes in the right eye.
Applicable To
- Early dry AMD with few small drusen or pigmentary changes
Excludes
- Exudative AMD (H35.32-)
Clinical Validation Requirements
- Presence of few small drusen (≤63µm) or pigmentary changes
Code-Specific Risks
- Risk of using unspecified codes if laterality or stage is not documented.
Coding Notes
- Ensure documentation specifies laterality and stage to avoid unspecified coding.
H35.3132 - Nonexudative age-related macular degeneration, bilateral, intermediate stage
Use when intermediate stage dry AMD is diagnosed bilaterally with specific findings.
Applicable To
- Intermediate dry AMD with large drusen or extensive intermediate drusen
Excludes
- Exudative AMD (H35.32-)
Clinical Validation Requirements
- Presence of ≥1 large drusen (>125µm) or extensive intermediate drusen (63–124µm)
Coding Notes
Ensure documentation specifies bilateral involvement and stage 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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dry Macular Degeneration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.3111.
Impact
Clinical: May lead to incorrect staging and treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Train staff on the importance of documenting drusen size., Implement EHR prompts for drusen size entry.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of non-compliance with coding guidelines., Data Quality: Reduces the accuracy of health data records.
Mitigation Strategy
Ensure documentation includes laterality and stage to select the most specific code.
Impact
Using unspecified codes when specific details are available.
Mitigation Strategy
Implement regular audits and training to ensure documentation supports specific coding.
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 Dry Macular Degeneration, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dry Macular Degeneration
Use these documentation templates to ensure complete and accurate documentation for Dry Macular Degeneration. These templates include all required elements for proper coding and billing.
Documenting intermediate dry AMD
Specialty: OphthalmologyRequired Elements
- Visual acuity measurements
- Fundus examination findings
- OCT imaging results
- Specific drusen size and location
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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