Documenting Cataracts with ICD-10 and CPT Codes

Documenting Cataracts with ICD-10 and CPT Codes

A cataract is a clouding of the normally clear lens of your eye. The article provides an overview of this eye condition along with the medical codes.

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A cataract is a cloudy area that forms in the lens of the eye that significantly affects vision. Regarded as the main cause of vision loss among people above 40 years of age, cataract begins when proteins in the eye form clumps that prevent the lens from sending clear images to the retina. The retina works by converting the light that comes through the lens into signals.

It sends the signals to the optic nerve, which carries them to the brain.

Generally, cataracts develop slowly and do not interfere with your eyesight early on. It can occur in one or both eyes but won't spread like an infection from one eye to the other. However, with passing years, the eye condition will significantly interfere with your vision. Initially, stronger lighting and eyeglasses can help you deal with cataracts. Cataract surgery may be required in extreme cases if the vision interferes with your day-to-day activities. Proper clinical documentation is important to help medical coding service providers assign the correct medical codes for appropriate reimbursement.

According to the National Eye Institute, more than half of people in the United States have cataracts or have undergone cataract surgery by the time they reach 80 years old. It is estimated that about 40 percent of US people aged 65 years or above have some degree of lens clouding. Any person can develop a cataract, as age is one of the most predominant risk factors. Aging or injury changes the tissues that make up your eye's lens.

Other underlying causes include – genetic disorders, an overproduction of oxidants (oxygen molecules), habit of smoking, long-term exposure to bright sunlight,

long-term

use

of

steroid

medications,

previous

eye

inflammation/injury/surgery, diseases like diabetes and exposure to ionizing radiation.

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Types of Cataracts All cataracts are fundamentally a change in the clarity of the overall lens structure. However, in some cases, cataracts may occur either early in life or as a result of aging. Cataract types include 

Nuclear cataract – Typically associated with aging, this type forms deep in the central zone (nucleus) of the lens.

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Sub capsular cataract – This type of cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing this condition.

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Cortical cataract – These are wedge-shaped opacities or streaks that form on the outer edge of the lens cortex.

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Congenital cataract – This type of cataract may be present at birth or form during a baby’s first year.

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Traumatic cataract – This type develops soon after an injury to the eye, but it can take several years for this to happen.

What Are the Typical Symptoms?

In most cases, cataracts take years to develop and they tend to appear in older age. As the condition develops slowly, most people do not know the exact causes. However, as the lens clouding progresses, the vision gradually gets worse. Long-distance vision is more severely affected at the beginning.

Cataracts often affect both the eyes, but rarely equally. Common symptoms include – 

Blurry vision

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Trouble seeing at night

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Increased sensitivity to glare

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Halos surrounding lights

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Double vision in the affected eye

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

Need for frequent changes in prescription glasses

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Need for brighter light for reading and other activities

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Fading or yellowing of colors

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Double vision in a single eye

During the initial stages of the cataract growth, the cloudiness in your vision may affect only a small part of the eye’s lens. In such cases, people may be quite unaware about the vision loss. However, as the cataract grows larger, it clouds more of your lens and distorts the light passing through the lens.

Diagnosing and Treating Cataracts Initial diagnosis of this eye condition will begin with a comprehensive eye exam to check for cataracts and to assess your vision. This will include an eye chart test to check your level of vision at different distances. In addition, Tonometry test will be conducted to adequately measure your eye pressure.

This test uses a painless puff of air to flatten your cornea and test your degree of eye pressure. Ophthalmologists will also put drops in your eyes to make your pupils bigger. This makes it easier to check the optic nerve and retina at the back of your eye for damage. In addition, several other tests like - Visual acuity test, Slit-lamp examination and Retinal exam are used to measure the level of vision.

When symptoms of this eye condition begin to appear, your ophthalmologist or eye specialist may ask you to wear stronger eyeglasses, magnifying lenses, or sunglasses with an anti-glare coating. Surgery will be considered as a last resort when cataracts prevent you from going about your daily activities, such as reading or driving. It’s also performed when cataracts interfere with the treatment of other eye problems. Surgery to remove a cataract is generally safe and has a high success rate.

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Cataract surgery may be of two different types. Phacoemulsification involves the use of ultrasound waves to break the lens apart and remove the pieces.

Extra-capsular surgery on the other hand, involves removing the cloudy part of the lens through a long incision in the cornea. After surgery, an artificial intraocular lens is placed where the natural lens was positioned. Most people can go home the same day after the surgery.

Ophthalmology medical coding involves using ICD-10-CM and CPT codes for reporting cataracts on your medical claims.

ICD-10 Codes H25 - Age-related cataract 

H25.0 - Age-related incipient cataract

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H25.1 - Age-related nuclear cataract

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H25.2 - Age-related cataract, morgagnian type

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H25.8 - Other age-related cataract

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H25.9 - Unspecified age-related cataract

H26 - Other cataract 

H26.0 - Infantile and juvenile cataract

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H26.1 - Traumatic cataract

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H26.2 - Complicated cataract

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H26.3 - Drug-induced cataract

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H26.4 - Secondary cataract

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H26.8 - Other specified cataract

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H26.9 - Unspecified cataract

H27 - Other disorders of lens 

H27.0 - Aphakia

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H27.1 - Dislocation of lens

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

H27.8 - Other specified disorders of lens

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H27.9 - Unspecified disorder of lens

H28 - Cataract in diseases classified elsewhere CPT Codes 

92273 - Electroretinography (ERG), with interpretation and report; full field

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92274 - Electroretinography (ERG), with interpretation and report; multifocal

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0509T - Electroretinography (ERG) with interpretation and report; pattern (PERG)

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0514T - Intraoperative visual axis identification using patient fixation (list separately in addition to code for primary procedure)

If left untreated, cataracts can interfere with your day-to-day activities and in some cases lead to blindness. Even though surgical removal of cataracts is a highly effective procedure, there are several other techniques that can be followed to prevent the occurrence of this eye condition in the long run.

These prevention tips include – conducting regular eye examinations, quitting the habit of smoking, wearing sunglasses (that block UV radiation), eating fruits and vegetables that contain antioxidants and keeping diabetes and other medical conditions in control.

Choosing the correct medical codes from a huge list of codes can be difficult, unless the coder has a clear idea about the same. For accurate and timely medical billing and claims submission, opthalmology practices can consider outsourcing their medical coding tasks to a professional medical billing and coding company that provides the services of AAPC-certified coding specialists.

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