ICD-10 Coding for Preretinal Fibrosis(H35.561, H35.562, H35.563, H35.569)
Complete ICD-10-CM coding and documentation guide for Preretinal Fibrosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Preretinal Fibrosis
H35.56Primary Range
Preretinal fibrosis/macular pucker
This range includes specific codes for preretinal fibrosis with laterality.
Other disorders of vitreous body
Includes vitreous strands or traction that may accompany preretinal fibrosis.
Type 2 diabetes mellitus with ophthalmic complications
Used when preretinal fibrosis is related to diabetic retinopathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H35.561 | Preretinal fibrosis, right eye | Use when preretinal fibrosis is confirmed in the right eye. |
|
| H35.562 | Preretinal fibrosis, left eye | Use when preretinal fibrosis is confirmed in the left eye. |
|
| H35.563 | Preretinal fibrosis, bilateral | Use when preretinal fibrosis is confirmed in both eyes. |
|
| H35.569 | Preretinal fibrosis, unspecified eye | Use when preretinal fibrosis is confirmed but laterality is not specified. |
|
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 preretinal fibrosis
Essential facts and insights about Preretinal Fibrosis
Primary ICD-10-CM Codes for preretinal fibrosis
Decision Criteria
clinical Criteria
- Presence of epiretinal membrane on OCT
documentation Criteria
- Documented laterality of the condition
Applicable To
- Epiretinal membrane, right eye
- Macular pucker, right eye
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Amsler grid distortion
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure OCT findings are documented to support the diagnosis.
H35.562 - Preretinal fibrosis, left eye
Use when preretinal fibrosis is confirmed in the left eye.
Applicable To
- Epiretinal membrane, left eye
- Macular pucker, left eye
Excludes
- Macular hole (H35.3-)
- Diabetic macular edema (E11.31-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Amsler grid distortion
Coding Notes
Ensure OCT findings are documented to support the diagnosis.
H35.563 - Preretinal fibrosis, bilateral
Use when preretinal fibrosis is confirmed in both eyes.
Applicable To
- Epiretinal membrane, bilateral
- Macular pucker, bilateral
Excludes
- Macular hole (H35.3-)
- Diabetic macular edema (E11.31-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Amsler grid distortion
Coding Notes
Ensure OCT findings are documented to support the diagnosis.
H35.569 - Preretinal fibrosis, unspecified eye
Use when preretinal fibrosis is confirmed but laterality is not specified.
Applicable To
- Epiretinal membrane, unspecified eye
- Macular pucker, unspecified eye
Excludes
- Macular hole (H35.3-)
- Diabetic macular edema (E11.31-)
Clinical Validation Requirements
- OCT showing epiretinal membrane
- Amsler grid distortion
Coding Notes
Ensure OCT findings are documented to support the diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other disorders of vitreous body
H43.89Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Macular hole
H35.3-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Preretinal Fibrosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.561.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials due to lack of supporting evidence.
Mitigation Strategy
Ensure OCT is performed and results are documented for all suspected cases., Train staff on the importance of including imaging findings in records.
Impact
Clinical: Inaccurate patient records affecting continuity of care., Regulatory: Non-compliance with specificity requirements., Financial: Increased risk of claim denials or reduced reimbursement.
Mitigation Strategy
Implement checklists to ensure all required details are documented., Regular audits of documentation practices.
Impact
Reimbursement: Claims may be denied or delayed due to unspecified laterality., Compliance: Non-compliance with coding guidelines requiring specificity., Data Quality: Inaccurate data collection affecting patient records.
Mitigation Strategy
Always document the affected eye(s) to use the correct laterality code.
Impact
Reimbursement: Incorrect coding may lead to inappropriate billing., Compliance: Failure to comply with coding specificity requirements., Data Quality: Misleading clinical data affecting treatment decisions.
Mitigation Strategy
Differentiate based on OCT findings and clinical presentation.
Impact
Failure to document laterality can lead to audit findings and claim denials.
Mitigation Strategy
Implement mandatory fields for laterality in EHR systems.
Impact
Lack of OCT documentation may result in unsupported diagnoses.
Mitigation Strategy
Require OCT reports for all preretinal fibrosis diagnoses.
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 Preretinal Fibrosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Preretinal Fibrosis
Use these documentation templates to ensure complete and accurate documentation for Preretinal Fibrosis. These templates include all required elements for proper coding and billing.
Post-Operative Follow-Up
Specialty: OphthalmologyRequired Elements
- Patient identification
- Procedure details
- Post-operative findings
- Follow-up plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Initial Diagnosis
Specialty: OphthalmologyRequired Elements
- Patient symptoms
- Clinical findings
- Diagnostic imaging
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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