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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:

Malattia LeventineseDoyne Honeycomb Dystrophy

Related ICD-10 Code Ranges

Complete code families applicable to Familial Drusen

H35.5Primary Range

Hereditary retinal dystrophies

This range includes genetic conditions affecting the retina, such as familial drusen.

Degenerative myopia

This range includes specific codes for macular degeneration, which may be used as ancillary codes for macular involvement in familial drusen.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
H35.5Hereditary retinal dystrophyUse when familial drusen is confirmed by genetic testing and family history.
  • Family history of retinal dystrophy
  • Genetic testing confirming EFEMP1 mutation
  • Imaging showing radial drusen pattern
H35.363Degenerative drusen of macula, bilateralUse as a secondary code when bilateral macular involvement is documented.
  • Imaging showing bilateral macular involvement
  • Fundus autofluorescence patterns

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

The ICD-10 code for familial drusen is H35.5, used for hereditary retinal dystrophies.

Primary ICD-10-CM Codes for familial drusen

Hereditary retinal dystrophy
Non-billable Code

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.

Ancillary Codes

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

Degenerative drusen of macula, bilateral

H35.363
Use when bilateral macular involvement is confirmed by imaging.

Differential Codes

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

Unspecified macular degeneration

H35.30
Use H35.5 for hereditary conditions; H35.30 is for unspecified or age-related cases.

Exudative age-related macular degeneration

H35.32-
Differentiate based on age and presence of exudative changes.

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: Ophthalmology

Required Elements

  • Family history
  • Genetic testing results
  • Imaging findings

Example Documentation

Patient presents with radial drusen pattern on OCT. Family history reveals father diagnosed with Malattia Leventinese. EFEMP1 mutation confirmed.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Drusen observed in both eyes.
Good Documentation Example
Radial drusen pattern observed on OCT, consistent with familial drusen. EFEMP1 mutation confirmed.
Explanation
The good example specifies the genetic basis and imaging findings, supporting the use of H35.5.

Need help with ICD-10 coding for Familial Drusen? Ask your questions below.

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