Use This Guide to Code Congenital Eye Conditions Correctly
Learn how often congenital glaucoma occurs. From conception, the eye begins to develop as early as six weeks’ gestation and is fully developed by birth. There are instances when part of the eye fails to develop correctly, or at all, during the gestational process. While rare, congenital eye conditions are important to know how to code for when a record enters your workflow. Read on to learn about different congenital eye conditions and the ICD-10-CM codes that are used for each one. Explore the Eye From Conception Congenital conditions are present from birth and may complicate ocular development due to genetic mutations, medication during pregnancy, or environmental factors such as toxins; or they may be symptomatic of other developmental disorders or systemic diseases. Some conditions are milder than others and some are rarer, but all have an impact on proper eye function. Congenital conditions are encompassed in Chapter 17 of ICD-10-CM code book and are further classified by conditions affecting the different parts of the visual system include: Identify Eyelid Malformation Codes Codes under parent code Q10.- (Congenital malformations of eyelid, lacrimal apparatus and orbit) identify malformations of the ocular adnexa, the external components of the eye responsible for physical health and protection. This includes the eyelids and lashes; the lacrimal system responsible for creating, distributing, and draining natural tears; and the orbit, which is the bony skull cavity housing the eyeball. Abnormalities with the adnexa are among the more common congenital ocular conditions, though prevalence fluctuates by condition and statistics aren’t widely documented. Assign Q10.0 (Congenital ptosis) when one or both upper eyelids droop due to underdeveloped muscles. Ectropion is a condition where one or both eyelids turn outward at birth, exposing the inner surface and leading to irritation. Use Q10.1 (Congenital ectropion) to report the diagnosis. Entropion is the inward turning of one or both eyelids, causing the eyelashes to rub against the eyeball. Report Q10.2 (Congenital entropion) for a congenital entropion diagnosis. Use Q10.4 (Absence and agenesis of lacrimal apparatus) to report a defect in or lack of part(s) of the system responsible for producing, distributing, and draining tears. An abnormally narrow or constricted tear duct can cause tear drainage issues. Assign Q10.5 (Congenital stenosis and stricture of the lacrimal duct) for the diagnosis. Use Q10.7 (Congenital malformation of the orbit) to report any defect in the bony cavity surrounding the eye, causing issues with eye position, movement, or function. Memorize Microphthalmos and Macophthalmos Coding Category Q11.- (Anophthalmos, microphthalmos and macrophthalmos) includes anomalies of the physical size of the eyeball or a complete absence of the eyeball. According to the Centers for Disease Control and Prevention (CDC), an estimated one in 5,100 babies born in the U.S. are affected by anophthalmos or microphthalmos. Macrophthalmos occurs even less frequently. Vision can’t be restored to an underdeveloped eye; management focuses on manipulation of the eye socket as the baby grows so that the skull develops properly and a prosthetic eye may be inserted in the future. Use Q11.0 (Cystic eyeball) when the eyeball fails to form in utero and is replaced by a fluid-filled cyst in the orbit. You’ll assign Q11.1 (Other anophthalmos) for the absence of the eyeball as well as the ocular tissue. Microphthalmos, Q11.2 (Microphthalmos), occurs when one or both eyeballs are unusually small and may have accompanying structural abnormalities. On the other hand, use Q11.3 (Macrophthalmos) when the patient has an abnormally large eyeball (one or both eyes). Learn to Code Lens Malformations Codes in Q12.- (Congenital lens malformations) involve deformities of the lens, the component of the visual system responsible for focusing light onto the retina. Malformations, which develop during fetal growth, may affect the shape, size, position, or transparency of the lens. Code Q12.0 (Congenital cataract) refers to a partial or complete clouding of the natural lens of the eye that develops in utero and is present from birth. Mild congenital cataracts may not interfere with normal visual development, while more severe congenital cataracts may require surgery in infancy to remove the cataract and prevent other future visual complications. Use Q12.1 (Congenital displaced lens) when the provider identifies that the lens of the eye is dislocated from its correct position. You’ll assign Q12.2 (Coloboma of lens) to refer to a failure of part of the lens to form correctly, resulting in a gap or cleft in the lens. Code Q12.3 (Congenital aphakia) is reported when a baby is born without the natural lens in one or both eyes. The lens may fail to form, or may begin to form but be expelled or absorbed by the body during birth due to a congenital infection. You’ll use Q12.4 (Spherophakia) to report a spherophakia diagnosis, which is a smaller-than-normal, misshapen lens that alters how light is focused onto the retina and potentially causes lens dislocation. Use Q13.- for Abnormalities at the Front of the Eye Category Q13.- (Congenital malformations of anterior segment of eye) identifies congenital malformations of the anterior segment, which is the front part of the eye including the cornea, sclera, iris, and pupil. Deficiencies here can lead to functional impairments or visual complications. You’ll assign Q13.0 (Coloboma of iris) when the provider identifies a gap or defect in the structure of the iris, which creates an irregularly shaped pupil and affects how light enters the eye. Use Q13.1 (Absence of iris) when the physician documents that the patient’s iris is missing or nearly missing, leading to lack of control over how much light enters the eye. Other more rare conditions include: Look to Q14.- for Back of the Eye Malformations Codes under parent code Q14.- (Congenital malformations of posterior segment of eye) surround the posterior segment, or the inner and back parts of the eye including the retina, optic nerve, and choroid. These malformations might include abnormal development or decreased function, will vary in severity, and may affect vision or visual development depending on their extent and location. Vitreous humor malformation: An abnormality in the gel-like substance filling the space between the lens and retina, which maintains the shape of the eye and protects the eye from injury due to blunt force. Use Q14.0 (Congenital malformation of vitreous humor) to report this diagnosis. Retina malformation: Report any retinal structural anomaly that is present from birth, such as coloboma (a hole or undeveloped area of the retina) or retinopathy of prematurity (abnormal development of retinal blood vessels) with Q14.1 (Congenital malformation of retina). Optic disc malformation: Use Q14.2 (Congenital malformation of optic disc) to report the improper formation of the area where the optic nerve connects to the retina, hindering proper visual information transmission from the eye to the brain. Choroid malformation: Assign Q14.3 (Congenital malformation of choroid) when the provider identifies a structural defect or abnormality in the choroid layer, which supplies oxygen and nutrients to the retina. Learn How to Code Other Malformations of the Eye Category Q15.- (Other congenital malformations of eye) identifies conditions including glaucoma, and encompasses birth defects that impact eye development, function, or vision. These defects can affect any part of the eye, including the lens, iris, retina, and other structures. Assign Q15.8 (Other specified congenital malformations of eye) for an abnormality not defined by a unique code. Use Q15.9 (Congenital malformation of eye, unspecified) when documentation of a condition does not allow a more specific code. On the other hand, you’ll report Q15.0 (Congenital glaucoma) for a diagnosis of glaucoma that’s present from birth. This condition occurs when the eye’s aqueous humor doesn’t drain properly or effectively. The fluid buildup causes increased pressure, which can damage the optic nerve. This congenital condition occurs in one of every 10,000 births, making it more common than some congenital abnormalities. Though congenital eye malformations raise alarm for new parents, many conditions are manageable and treatable, allowing a baby to grow up with vision as normal as possible. When detected early, chances are greater of correcting a defect or intervening in a complication, thus resulting in the opportunity for better eye health and visual outcomes. Christine Killeen CPC, CPB, COPC, Contributing Writer
