Simplify Your Complicated Cataract Coding Confusion
Know when to report complex versus standard cataract surgery. As the human eye ages, the development of cataracts is a near certainty for most adults. Clouding of the eye’s lens is a natural part of the aging process. Not every patient will experience symptoms, and not all will require cataract surgery; however, for the majority of aging eyes, a cataract will develop eventually. Continue reading to learn how to code the different complicated cataract diagnoses. Familiarize Yourself With Complicated Cataract Conditions A complicated cataract occurs when the clouding of the lens is the result of something other than the natural aging process, or when it develops concurrently with another ocular condition. The H26.2- (Complicated cataract) ICD-10-CM code category encompasses cataracts that develop from other systemic factors as opposed to external influences, such as trauma or drugs, which are defined in another ICD-10-CM code family. Each code subcategory also has specific notations, such as Code first or Code also. The parent code, H26.- (Other cataract), features an Excludes1 note for Q12.0 (Congenital cataract), which you should never report along with any H26.- code. Congenital cataracts are present at birth, whereas cataracts in the H26.2- category develop naturally, either as part of the aging process or due to another condition. Nail Down Cataracts With Neovascularization Neovascularization is the growth of new, abnormal blood vessels, often in areas where they are not normally present. Cataract with neovascularization involves clouding of the natural lens along with the development of blood vessels, usually in or around the iris and lens capsule. These blood vessels may develop as the result of: The combination of lens clouding and new vessel formation may cause blurry vision, light sensitivity, difficulty seeing in low light, glare or halos around lights, red eyes, and eye pain. Use code H26.21- (Cataract with neovascularization) with the appropriate 6th character to specify laterality to report this condition. Code H26.21- has a Code also note to assign the ICD-10-CM codes for any associated conditions, if applicable. Use H26.22- When Other Eye Conditions Cause a Cataract You’ll assign H26.22- (Cataract secondary to ocular disorders (degenerative) (inflammatory)) for clouding of the lens that develops because of another eye condition — such as an underlying inflammatory disorder or an infection — or another ocular complication. These conditions may be degenerative (progressively damaging) or inflammatory (involving swelling or irritation). Symptoms include blurry vision or visual difficulties, light sensitivity, difficulty seeing in low light, and glare or halos around lights. A Code also note for H26.22- instructs you to use an additional ICD-10-CM code for the condition leading to the development or acceleration of a cataract. Find out How to Code Glaucomatous Flecks Glaucomatous flecks, also called subcapsular cataracts, refer to small, cloudy deposits that form beneath the capsule of the lens in individuals with glaucoma. These deposits collect on the back surface of the lens and may interfere with vision, especially in bright light or while reading. Mild cases may be manageable with prescription glasses; more advanced cases may require correction by cataract surgery. Use the H26.23- (Glaucomatous flecks (subcapsular)) subcategory to report this condition. You’ll need a 6th character to indicate if the left eye, right eye, or both eyes are affected, or if the physician didn’t specify laterality. Also, a Code first note directs you to assign the appropriate code from the H40.- (Glaucoma) through H42 (Glaucoma in diseases classified elsewhere) glaucoma codes. Report Treatment Codes When surgical intervention becomes necessary, surgeons extract cataracts complicated by other factors in the same manner as a straightforward age-related cataract. The surgeon makes a corneal incision to access the lens, which is then broken apart and removed from the eye. The surgeon uses phacoemulsification (ultrasonic energy followed by aspiration of the fragments) or, less commonly, a manual technique to remove the lens. Following removal of the lens, the surgeon places an intraocular lens (IOL) to mimic the natural lens of the eye. Conditions like miosis (constricted pupils) or floppy iris (when the iris shifts out of normal position) may require additional measures, such as an iris expansion device to aid in enlargement of the pupil, or iris hooks to stabilize a floppy iris. This is considered complex cataract surgery. It is important to note that complicated does not automatically equate to complex when it comes to cataracts. Assign one of the following CPT® codes for standard or complex surgery: More complicated procedures are not always necessary to treat a complicated cataract. Additional measures may be necessary to treat the complicating condition, such as continued medications for the treatment of uveitis. However, standard cataract surgery is often enough to resolve the patient’s visual difficulties. Code These Real-World Scenarios Scenario 1: A patient who suffers from chronic uveitis is now experiencing blurry vision and halos around lights. The patient also complains of intermittent eye pain and sensitivity to light. A cataract evaluation finds bilateral cataracts have developed, accelerated by inflammation from the patient’s uveitis. Following treatment of the uveitis to decrease the inflammation, cataract surgery is indicated to address the patient’s visual complications. The correct ICD-10-CM coding for this scenario is H26.223 (Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral), followed by H20.13 (Chronic iridocyclitis, bilateral). Scenario 2: A patient presents for cataract evaluation upon realizing they’re having difficulty reading street signs and driving at night. The patient also complains of intermittent eye pain and sensitivity to light. The exam finds a cataract in the right eye, along with the growth of new blood vessels around the iris, though the origin of the blood vessels is undetermined. The decision is made for cataract extraction, followed by a series of anti-vascular endothelial growth factor (anti-VEGF) injections to slow or stop the growth of blood vessels. The correct diagnosis for this patient is H26.211 (Cataract with neovascularization, right eye). In this instance, you cannot assign a second ICD-10-CM code without information regarding the source of blood vessel growth. Because the Code also note specifies “if applicable,” you can report the ICD-10-CM code for the cataract without a secondary condition. Cataracts may be complicated, but coding them doesn’t have to be! Christine Killeen CPC, CPB, CPMA, COPC, Contributing Writer
