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Question Coding for Cataracts

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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.


True Blue
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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:

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?

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.