ICD-10 Coding for Nuclear Sclerosis(H25.11, H25.12, H25.13)
Complete ICD-10-CM coding and documentation guide for Nuclear Sclerosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Nuclear Sclerosis
H25.1-H25.13Primary Range
Age-related nuclear cataract
This range covers nuclear sclerosis, a common type of age-related cataract.
Combined forms of age-related cataract
Used when nuclear sclerosis coexists with other cataract types like cortical or subcapsular.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H25.11 | Age-related nuclear cataract, right eye | Use when nuclear sclerosis is documented in the right eye. |
|
| H25.12 | Age-related nuclear cataract, left eye | Use when nuclear sclerosis is documented in the left eye. |
|
| H25.13 | Age-related nuclear cataract, bilateral | Use when nuclear sclerosis is documented 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 nuclear sclerosis
Essential facts and insights about Nuclear Sclerosis
Primary ICD-10-CM Codes for nuclear sclerosis
Decision Criteria
clinical Criteria
- Presence of nuclear sclerosis in the right eye
Applicable To
- Nuclear sclerosis, right eye
Excludes
- Capsular glaucoma with pseudoexfoliation (H40.1-)
Clinical Validation Requirements
- Slit-lamp findings of nuclear color and opalescence
- BCVA ≤20/40 with glare testing
Code-Specific Risks
- Incorrectly coding without laterality
- Assuming age-related without documentation
Coding Notes
- Ensure laterality is documented.
H25.12 - Age-related nuclear cataract, left eye
Use when nuclear sclerosis is documented in the left eye.
Applicable To
- Nuclear sclerosis, left eye
Excludes
- Capsular glaucoma with pseudoexfoliation (H40.1-)
Clinical Validation Requirements
- Slit-lamp findings of nuclear color and opalescence
- BCVA ≤20/40 with glare testing
Coding Notes
Ensure laterality is documented.
H25.13 - Age-related nuclear cataract, bilateral
Use when nuclear sclerosis is documented in both eyes.
Applicable To
- Nuclear sclerosis, both eyes
Excludes
- Capsular glaucoma with pseudoexfoliation (H40.1-)
Clinical Validation Requirements
- Slit-lamp findings of nuclear color and opalescence
- BCVA ≤20/40 with glare testing
Coding Notes
Ensure laterality is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Insulin use
Z79.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other specified cataract
H26.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Nuclear Sclerosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H25.11.
Impact
Clinical: Ambiguous clinical records, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always include laterality in clinical notes.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Code H25.81- when nuclear and other cataract types coexist.
Impact
Reimbursement: Potential claim rejections., Compliance: Violation of coding standards., Data Quality: Misleading clinical data.
Mitigation Strategy
Require explicit nuclear characteristics documentation.
Impact
Failure to document laterality can lead to audit issues.
Mitigation Strategy
Ensure laterality is always documented in patient records.
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 Nuclear Sclerosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Nuclear Sclerosis
Use these documentation templates to ensure complete and accurate documentation for Nuclear Sclerosis. These templates include all required elements for proper coding and billing.
Ophthalmology H&P
Specialty: OphthalmologyRequired Elements
- Location of nuclear opacity
- Laterality
- Grade of cataract
- Visual impact
- Surgical indicators
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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