ICD-10 Coding for Familial Drusen(H35.5, H35.363)
Complete ICD-10-CM coding and documentation guide for Familial Drusen. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Familial Drusen
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.5 | Hereditary retinal dystrophy | Use when familial drusen is confirmed by genetic testing and family history. |
|
| H35.363 | Degenerative drusen of macula, bilateral | Use as a secondary code when bilateral macular involvement is 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 familial drusen
Essential facts and insights about Familial Drusen
Primary ICD-10-CM Codes for familial drusen
Decision Criteria
clinical Criteria
- Presence of EFEMP1 mutation and family history
coding Criteria
- Avoid using unspecified codes for hereditary conditions
Applicable To
- Familial drusen
- Malattia Leventinese
Excludes
- Peripheral retinal degeneration (H35.4)
Clinical Validation Requirements
- Family history of retinal dystrophy
- Genetic testing confirming EFEMP1 mutation
- Imaging showing radial drusen pattern
Code-Specific Risks
- Misclassification as age-related macular degeneration
- Failure to document genetic basis
Coding Notes
- Ensure documentation specifies genetic testing and family history to support hereditary classification.
H35.363 - Degenerative drusen of macula, bilateral
Use as a secondary code when bilateral macular involvement is documented.
Applicable To
- Bilateral macular drusen
Excludes
- Hereditary retinal dystrophy (H35.5)
Clinical Validation Requirements
- Imaging showing bilateral macular involvement
- Fundus autofluorescence patterns
Coding Notes
Ensure bilateral involvement is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Degenerative drusen of macula, bilateral
H35.363Differential 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 Familial Drusen to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.5.
Impact
Clinical: May lead to inappropriate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document laterality in clinical notes.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data affecting patient records.
Mitigation Strategy
Use H35.5 for hereditary conditions and specify laterality with ancillary codes.
Impact
High risk of audit for using unspecified macular degeneration codes.
Mitigation Strategy
Use specific codes like H35.5 with documented genetic evidence.
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 Familial Drusen, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Familial Drusen
Use these documentation templates to ensure complete and accurate documentation for Familial Drusen. These templates include all required elements for proper coding and billing.
Initial diagnosis of familial drusen
Specialty: OphthalmologyRequired Elements
- Family history
- Genetic testing results
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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