ICD-10 Coding for Presbyopia(H52.4)
Complete ICD-10-CM coding and documentation guide for Presbyopia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Presbyopia
H52.4Primary Range
Disorders of refraction and accommodation
Primary code for presbyopia, indicating age-related loss of accommodation.
Key Information: ICD-10 code for presbyopia
Essential facts and insights about Presbyopia
Primary ICD-10-CM Code for presbyopia
Decision Criteria
clinical Criteria
- Age ≥40 with reduced accommodative amplitude and near vision difficulty.
coding Criteria
- Do not use if accommodation loss is due to another condition.
Applicable To
- Age-related loss of accommodation
Excludes
- Accommodative spasm (H51.8)
Clinical Validation Requirements
- Age ≥40
- Reduced accommodative amplitude (≤2.00 D)
- Near vision difficulty
Code-Specific Risks
- Incorrectly coding when an underlying condition affects accommodation.
Coding Notes
- Sequence H52.4 first when presbyopia is the primary reason for encounter.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Presbyopia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H52.4.
Impact
Clinical: Misdiagnosis risk., Regulatory: Potential audit failure., Financial: Claim denial due to insufficient documentation.
Mitigation Strategy
Always document patient age., Include age-related criteria in 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 H52.4 only for age-related loss; use H51.8 for accommodative disorders.
Impact
H52.4 without age documentation can trigger audits.
Mitigation Strategy
Ensure age is documented in all presbyopia cases.
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 Presbyopia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Presbyopia
Use these documentation templates to ensure complete and accurate documentation for Presbyopia. These templates include all required elements for proper coding and billing.
Presbyopia diagnosis in ophthalmology
Specialty: OphthalmologyRequired Elements
- Chief complaint
- History of present illness
- Visual acuity
- Accommodative amplitude
- Medical decision making
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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