Wiki Coding for Cataracts

[janettleona@gmail.com]

Hi

The provider listed and addressed Age related Cataract and DM with diabetic Cataract. Can she keep both or does she need to specify which is the correct diagnosis. I believe we would not use both and to keep DM with Catarac. It would appreciate some feedback.

 

[fwnewbie]

That's a good question! I'm waiting along with you for the answer! lol

 

[thomas7331]

There is an Excludes2 note for diabetes mellitus related eye conditions in Chapter 7 which includes the cataract codes. Per the guidelines, this 'indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.'

A similar question was also addressed by Coding Clinic in their second quarter 2019 publication:

Question:
A patient with cortical, nuclear, and posterior subcapsular cataracts of both eyes is seen for right phacoemulsification clear corneal intraocular lens implant. The patient also has type 2 diabetes. Should the cataracts be coded as diabetic complications?

Answer:
Yes, it is appropriate to assign a code for diabetic cataract, based on the classification's presumed relationship between diabetes and cataracts. Assign code E11.36, Type 2 diabetes mellitus with diabetic cataract. Assign also code H25.813, Combined forms of age-related cataract, bilateral for further specificity.

 

[rmwinder]

Since you are asking in the Risk Adjustment area, I'll answer according to that. : )

Under the 'with' guidelines for Diabetes, you would always code the combination code for DM w/ cataracts when they are documented in the same note. Even after a lens replacement if the verbiage indicates the lens or the capsule has become cloudy again.

If you are strictly capturing HCC codes, there would be no reason to capture the age-related cataract code - H25.813, as it doesn't risk adjust, not even for an RxHCC. But if your scope of work is that you would capture all diagnosis codes, then yes, use E11.36 and H25.813.

Which is basically what everyone else has said. : )

diagnosis codes, diagnosis coding