Outpatient Facility Coding Alert

Reader Question:

Identify Correct Dx for Colobama Situation

Published on Thu Mar 15, 2018

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Question: We have a patient diagnosed with colobama, but I'm not sure which ICD-10 code to report. Can you help me?

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Answer: When patients have colobomas, they were born without certain tissues that form their eyes. These colobomas are frequently seen in the iris because they are more obvious there since it's noticeable when part of the iris is missing. However, colobomas can also affect the other areas that aren't as easy to see on visual examination of the patient and can be slower to diagnose. When patients present with this condition, they could complain of the following symptoms, among others, which you should report in the absence of a confirmed diagnosis:

H53.8 - Other visual disturbances
H54.5x - Low vision, one eye
H53.45x - Other localized visual field defect.

If the ophthalmologist definitively diagnoses the patient with a coloboma, you'll bill the claim using the more specific code, depending on the location. Several options are listed below:

Q12.2 - Coloboma of lens
Q13.0 - Coloboma of iris
Q14.2 - Congenital malformation of optic disc
Q14.8 - Other congenital malformations of posterior segment of eye(for coloboma of the fundus).

If other conditions are associated with the coloboma, you can report them as well (such as glaucoma or strabismus), but do not report the signs and symptoms if the physician has definitively diagnosed the patient with coloboma.