Ophthalmology and Optometry Coding Alert

It’s likely that your practice codes cataract diagnoses on a daily basis, and often you’re billing the same codes over and over. But there are some cataract diagnoses that don’t fall into the standard codes, and those can be challenging to report. Check out the following three examples, and figure out the diagnosis codes you should report.

Diagnosis 1: Juvenile Cataracts

Scenario: A 10-year-old patient reports to the practice with poor vision in both eyes and her mother said her eyes “look cloudy.” The ophthalmologist examines the patient and diagnoses her with bilateral cortical cataracts. Which code applies?

Report this: In this situation, you’ll look to the “Infantile and juvenile cataract” section of ICD-10 (H26.0) and scroll down until you find the “Infantile and juvenile cortical, lamellar, or zonular cataract) range (H26.01).

Because the patient’s cortical cataracts affect both eyes, you’ll select H26.013 (Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral).

Diagnosis 2: Nuclear Cataracts

Scenario: A 72-year-old patient presents to the practice with blurred vision and slight yellow tinting to the left eye. The optometrist diagnoses the patient with a nuclear cataract due to her age. Which code should you report?

Report this: A nuclear cataract occurs when the patient has an excessive amount of yellowing in the eye causing central opacity, and in this case, the condition is age-related. To report this diagnosis, you’ll visit the H25.1 (Age-related nuclear cataract) section of ICD-10. Because the condition affects the patient’s left eye only, H25.12 (Age-related nuclear cataract, left eye).

Diagnosis 3: Drug-Induced Cataracts

Scenario: A 67-year-old female patient who has been on glucocorticoids for several years reports complaining of blurred vision. The physician diagnoses the patient with bilateral cataracts due to the glucocorticoid use. Which code applies?

Report this: When patients’ cataracts stem from drug use, you’ll report a code from the H26.3 (Drug-induced cataract) range. Because the patient’s cataracts affect both eyes, the right code is H26.33 (Drug-induced cataract, bilateral).

In addition, the ICD-10 manual indicates that you should report an additional code to reflect the adverse effect identifying the drug. Therefore, you’ll report T38.0X5 (Adverse effect of glucocorticoids and synthetic analogues) as the secondary diagnosis code.