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  • Savvy Coder

    ICD-10 Codes for the Cataract Family

    By Sue Vicchrilli, COT, OCS, Academy Director of Coding and Reimbursement, Jenny Edgar, CPC, CPCO, OCS, Academy Coding Specialist, and Rajiv Rathod, MD, MBA
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    How many different types of cataracts are there? According to ICD-10-CM, there are close to 70— ranging from age-related to zonular cataracts.

    Reporting laterality. For some codes, you include a number to indicate laterality: 1 for the right eye, 2 for the left eye, and 3 for both eyes. For most codes that require laterality, you report this number as the sixth character (e.g., H21.22- Degeneration of ciliary body), but there are some codes where it appears as the fifth character (e.g., H26.3-, Drug-induced cataract). And for other codes, you don’t report laterality at all.

    Where to Find Cataract Codes

    In ICD-10’s Tabular List, check the following chapters for cataract codes.

    • Chapter 7 Eye and ocular adnexa. See the Disorders of lens section (H25H28) for the most-used diagnoses. (For an ICD-9/ICD-10 conversion table of the most common ICD-9 cataract codes, see the Web Extra below.)
    • Chapter 4 Endocrine, nutritional and metabolic diseases. Examples include E10.36 Type 1 diabetes with diabetic cataract, E11.36 Type 2 diabetes with diabetic cataract, E20.9 Hypoparathyroidism, unspecified, E46 Unspecified protein-calorie malnutrition, E34.9 Endocrine disease, unspecified, E74.21 Galactosemia, and E88.9 Metabolic disorder, unspecified.
    • Chapter 17 Congenital malformations, deformations, and chromosomal abnormalities. Example: Q12.0- represents anterior and posterior axial embryonal, pyramidal, blue, central, cerulean, congenital, coralliform, coronary, and crystalline cataracts.
    • Chapter 6 Diseases of the nervous system. Example: G71.19 Other specified myotonic disorders.

    Web Extra: Savvy Coder
    Converting 5 Frequently Used ICD-9 Codes

    Complex Cataract Surgery—66982

    When you submit CPT code 66982, local coverage determinations (LCDs) require more than the traditional cataract diagnosis codes. To indicate why the surgery qualifies as complex, you also must report one of the following codes:

    H21.221 Degeneration of ciliary body, right eye

    H21.222 Degeneration of ciliary body, left eye

    H21.261 Iris atrophy (essential) (progressive), right eye

    H21.262 Iris atrophy (essential) (progressive), left eye

    H21.271 Miotic pupillary cyst, right eye

    H21.272 Miotic pupillary cyst, left eye

    H21.29 Other iris atrophy

    H21.531 Iridodialysis, right eye

    H21.532 Iridodialysis, left eye

    H21.561 Pupillary abnormality, right eye

    H21.562 Pupillary abnormality, left eye

    H21.81 Floppy iris syndrome

    H21.89 Other specified disorders of iris and ciliary body

    H21.9 Unspecified disorder of iris and ciliary body

    H22 Disorders of iris and ciliary body in diseases classified elsewhere

    H57.00 Unspecified anomaly of pupillary function

    H57.01 Argyll Robertson pupil, atypical

    H57.02 Anisocoria

    H57.03 Miosis

    H57.04 Mydriasis

    H57.051 Tonic pupil, right eye

    H57.052 Tonic pupil, left eye

    H57.09 Other anomalies of pupillary function

    H57.9 Unspecified disorder of eye and adnexa

    Q13.1 Absence of iris

    Q13.9 Congenital malformation of anterior segment of eye, unspecified

    YAG Capsulotomy—66821

    When submitting CPT code 66821, you can use these codes to indicate medical necessity:

    H26.491 Other secondary cataract, right eye

    H26.492 Other secondary cataract, left eye

    H26.493 Other secondary cataract, bilateral