ICD-10 Coding for Retinitis Pigmentosa(H35.52)
Complete ICD-10-CM coding and documentation guide for Retinitis Pigmentosa. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Retinitis Pigmentosa
H35.50-H35.59Primary Range
Hereditary retinal dystrophies
This range includes codes for various hereditary retinal dystrophies, with H35.52 specifically for retinitis pigmentosa.
Key Information: ICD-10 code for retinitis pigmentosa
Essential facts and insights about Retinitis Pigmentosa
Primary ICD-10-CM Code for retinitis pigmentosa
Decision Criteria
clinical Criteria
- Confirmed genetic mutation associated with RP
documentation Criteria
- Detailed fundoscopic findings and ERG results
Applicable To
- Retinitis pigmentosa
- Autosomal dominant retinitis pigmentosa
- Autosomal recessive retinitis pigmentosa
Excludes
- Other hereditary retinal dystrophies (H35.50)
Clinical Validation Requirements
- Electroretinography (ERG) showing reduced rod responses
- Genetic testing confirming pathogenic variants
- Fundoscopic findings of bone spicule pigmentation
Code-Specific Risks
- Misuse for suspected cases without confirmation
- Omitting necessary ancillary codes for symptoms
Coding Notes
- Ensure genetic confirmation or clinical validation before using H35.52.
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 Retinitis Pigmentosa to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H35.52.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Ensure genetic test results are included in all RP diagnoses., Regular audits of patient records.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate data on patient records.
Mitigation Strategy
Use symptom codes until RP is confirmed by genetic or clinical tests.
Impact
High risk of audit if H35.52 is used without genetic or clinical confirmation.
Mitigation Strategy
Require documentation of genetic testing or ERG results before coding.
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 Retinitis Pigmentosa, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Retinitis Pigmentosa
Use these documentation templates to ensure complete and accurate documentation for Retinitis Pigmentosa. These templates include all required elements for proper coding and billing.
Ophthalmology Progress Note for RP
Specialty: OphthalmologyRequired Elements
- Patient history
- Fundoscopic findings
- ERG results
- Genetic testing results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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