Ophthalmology and Optometry Coding Alert

Question: I’m not sure which diagnosis code to report when our ophthal­mologists diagnose a patient with cataracts and recommend surgery. Where can I find a list of ICD-10 codes that will support medical necessity?

Tennessee Subscriber

Answer: There are more than 110 ICD-10 codes that help demonstrate the medical necessity of cataract surgery, including the H25.011-H25.89 range for age-related cataracts and the H26.001-H26.8 range for other cataracts.

For the full list, check out Local Coverage Article A57196 (www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57196). Note that payer requirements may vary.

Be specific: Many of these codes have six characters, which specify details such as the kind of cataract and the affected eye(s). With all the documentation requirements for billing, there should be no need to report H25.9 (Unspecified age-related cataract) or H26.9 (Unspecified cataract).