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ICD-10 Coding for Exudative Age-Related Macular Degeneration(H35.3211, H35.3222, H35.3233)

Complete ICD-10-CM coding and documentation guide for Exudative Age-Related Macular Degeneration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Wet AMDNeovascular AMD

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Related ICD-10 Code Ranges

Complete code families applicable to Exudative Age-Related Macular Degeneration

H35.32Primary Range

Choroidal neovascularization

This range includes codes specific to exudative age-related macular degeneration, detailing laterality and activity status.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
H35.3211Exudative age-related macular degeneration, right eye, activeUse when there is active CNV in the right eye confirmed by imaging.
  • OCT showing subretinal fluid or intraretinal cysts
  • FFA showing classic or occult CNV
H35.3222Exudative age-related macular degeneration, left eye, inactiveUse when CNV in the left eye is inactive, confirmed by imaging.
  • Documented fibrosis or scarring without fluid on OCT for three consecutive visits
H35.3233Exudative age-related macular degeneration, bilateral, scarredUse when both eyes have scarred CNV confirmed by imaging.
  • Symmetric disciform scars greater than one disc area with BCVA ≤20/200 in 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 exudative age-related macular degeneration

Essential facts and insights about Exudative Age-Related Macular Degeneration

The ICD-10 code for exudative age-related macular degeneration depends on laterality and activity, such as H35.3211 for active CNV in the right eye.

Primary ICD-10-CM Codes for exudative age-related macular degeneration

H35.3211
Exudative age-related macular degeneration, right eye, active
Billable Code

Decision Criteria

clinical Criteria

  • Presence of subretinal fluid or intraretinal cysts in the right eye

documentation Criteria

  • Detailed imaging findings supporting active CNV

Applicable To

  • Active choroidal neovascularization in the right eye

Excludes

  • Nonexudative age-related macular degeneration

Clinical Validation Requirements

  • OCT showing subretinal fluid or intraretinal cysts
  • FFA showing classic or occult CNV

Code-Specific Risks

  • Incorrect laterality documentation
  • Failure to specify activity status

Coding Notes

  • Ensure documentation specifies laterality and CNV activity.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Other long term (current) drug therapy

Z79.899
Use to indicate ongoing anti-VEGF therapy.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Nonexudative age-related macular degeneration, right eye

H35.3111
No evidence of subretinal fluid or CNV activity on imaging.

Nonexudative age-related macular degeneration, left eye

H35.3122
Absence of CNV activity and fluid on imaging.

Nonexudative age-related macular degeneration, bilateral

H35.3133
No evidence of CNV activity or scarring.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Exudative Age-Related Macular Degeneration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.3211.

Impact

Clinical: Potential for incorrect treatment, Regulatory: Non-compliance with coding standards, Financial: Claim denials due to unspecified codes

Mitigation Strategy

Always document eye involvement, Use templates that prompt for laterality

Impact

Reimbursement: High denial rate for unspecified codes, Compliance: Increased audit risk, Data Quality: Inaccurate clinical data representation

Mitigation Strategy

Always specify laterality and activity status in documentation.

Impact

High audit risk for claims with unspecified laterality.

Mitigation Strategy

Implement mandatory fields for laterality in EHR systems.

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 Exudative Age-Related Macular Degeneration, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Exudative Age-Related Macular Degeneration

Use these documentation templates to ensure complete and accurate documentation for Exudative Age-Related Macular Degeneration. These templates include all required elements for proper coding and billing.

Progress Note for Active CNV

Specialty: Ophthalmology

Required Elements

  • Diagnosis
  • Imaging findings
  • Visual acuity
  • Treatment plan

Example Documentation

Diagnosis: Exudative AMD, right eye, active. Imaging: OCT showing subretinal fluid. BCVA: 20/80. Treatment: Anti-VEGF injection planned.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Wet AMD, both eyes, getting injections.
Good Documentation Example
Exudative AMD OU with active subfoveal CNV (OD > OS) confirmed by Spectralis OCT showing: OD: 300μm subretinal fluid + intraretinal cysts.
Explanation
The good example specifies laterality, CNV activity, and provides detailed imaging findings.

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