ICD-10 Coding for Macular Pucker(H35.371, H35.372, H35.373, H35.379)
Complete ICD-10-CM coding and documentation guide for Macular Pucker. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Macular Pucker
H35.37Primary Range
Macular pucker
This range includes all codes for macular pucker with specifications for laterality.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.371 | Macular pucker, right eye | Use when macular pucker is confirmed in the right eye. |
|
| H35.372 | Macular pucker, left eye | Use when macular pucker is confirmed in the left eye. |
|
| H35.373 | Macular pucker, bilateral | Use when macular pucker is confirmed in both eyes. |
|
| H35.379 | Macular pucker, unspecified eye | Use only when laterality cannot be determined. |
|
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 macular pucker
Essential facts and insights about Macular Pucker
Primary ICD-10-CM Codes for macular pucker
Decision Criteria
clinical Criteria
- Presence of epiretinal membrane on OCT.
Applicable To
- Epiretinal membrane, right eye
Excludes
- Macular hole (H35.34-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Visual acuity reduction
- Metamorphopsia
Code-Specific Risks
- Avoid using if laterality is unspecified.
Coding Notes
- Ensure laterality is documented.
H35.372 - Macular pucker, left eye
Use when macular pucker is confirmed in the left eye.
Applicable To
- Epiretinal membrane, left eye
Excludes
- Macular hole (H35.34-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Visual acuity reduction
- Metamorphopsia
Coding Notes
Ensure laterality is documented.
H35.373 - Macular pucker, bilateral
Use when macular pucker is confirmed in both eyes.
Applicable To
- Epiretinal membrane, both eyes
Excludes
- Macular hole (H35.34-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Visual acuity reduction
- Metamorphopsia
Coding Notes
Ensure laterality is documented.
H35.379 - Macular pucker, unspecified eye
Use only when laterality cannot be determined.
Applicable To
- Epiretinal membrane, unspecified eye
Excludes
- Macular hole (H35.34-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Visual acuity reduction
- Metamorphopsia
Coding Notes
Ensure laterality is documented.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Macular hole
H35.34-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Macular Pucker to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.371.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always verify and document laterality., Use standardized templates.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific eye affected.
Impact
Reimbursement: Incorrect coding can lead to improper billing., Compliance: Violates coding standards., Data Quality: Affects clinical data integrity.
Mitigation Strategy
Differentiate based on OCT findings and clinical presentation.
Impact
Using unspecified codes when laterality is documented.
Mitigation Strategy
Implement mandatory laterality documentation checks.
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 Macular Pucker, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Macular Pucker
Use these documentation templates to ensure complete and accurate documentation for Macular Pucker. These templates include all required elements for proper coding and billing.
Macular pucker diagnosis and treatment
Specialty: OphthalmologyRequired Elements
- Patient symptoms
- OCT findings
- Visual acuity tests
- Surgical plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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