ICD-10 Coding for Nasolacrimal Duct Obstruction(H04.551, Q10.5)
Complete ICD-10-CM coding and documentation guide for Nasolacrimal Duct Obstruction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Nasolacrimal Duct Obstruction
H04.55-H04.53Primary Range
Acquired and congenital nasolacrimal duct obstruction
This range includes codes for both acquired and congenital forms of nasolacrimal duct obstruction, which are the primary conditions addressed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H04.551 | Acquired stenosis of right nasolacrimal duct | Use for acquired stenosis of the right nasolacrimal duct confirmed by clinical examination. |
|
| Q10.5 | Congenital nasolacrimal duct obstruction | Use for congenital cases in infants with symptoms from birth. |
|
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 nasolacrimal duct obstruction
Essential facts and insights about Nasolacrimal Duct Obstruction
Primary ICD-10-CM Codes for nasolacrimal duct obstruction
Decision Criteria
clinical Criteria
- Confirmed acquired stenosis with clinical findings
Applicable To
- Idiopathic stenosis
- Post-inflammatory stenosis
Excludes
- Congenital stenosis (Q10.5)
Clinical Validation Requirements
- Slit-lamp exam showing tear meniscus >0.5mm
- Positive fluorescein dye test
Code-Specific Risks
- Incorrect laterality documentation
- Missing clinical validation
Coding Notes
- Ensure laterality is documented and matches the code used.
Q10.5 - Congenital nasolacrimal duct obstruction
Use for congenital cases in infants with symptoms from birth.
Applicable To
- Membranous obstruction at birth
Excludes
- Acquired stenosis (H04.55-)
Clinical Validation Requirements
- Persistent epiphora in infants
- Unresponsive to massage
Coding Notes
Ensure age and congenital nature are documented.
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 Nasolacrimal Duct Obstruction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H04.551.
Impact
Clinical: Leads to incorrect treatment planning., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Always document the side of obstruction, Use appropriate modifiers
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Misclassification affects compliance with coding standards., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Verify patient age and symptom onset to select the correct code.
Impact
Incorrect or missing modifiers can trigger audits.
Mitigation Strategy
Ensure all procedures have appropriate laterality modifiers.
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 Nasolacrimal Duct Obstruction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Nasolacrimal Duct Obstruction
Use these documentation templates to ensure complete and accurate documentation for Nasolacrimal Duct Obstruction. These templates include all required elements for proper coding and billing.
Adult with acquired nasolacrimal duct obstruction
Specialty: OphthalmologyRequired Elements
- Patient history
- Clinical findings
- Procedure details
- Outcome
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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