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  • ICD-10 Cataract/Anterior Segment Ask the Expert

    ICD-10 codes for complex cataract surgery


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    Question: How can I indicate to the payer that the cataract surgery was complex?

    Answer:
    Along with the cataract diagnosis, report the appropriate secondary ICD-10 code. For local carrier determinations (LCD) that allow mature cataract and use of dye, H25.89 alone is sufficient. Links to current LCD policies can be found at aao.org/lcds. The options listed in Medicare administrative contractor LCDs are:
    • Use H21.261-H21.263, , H21.29, H21.561-H21.563,  if the operative note indicates the use of an endocapsular ring to partially occlude the pupil.
    • Use H21.271-H21.273, , H26.211-H26.213, , H26.221-H26.223,  if the operative note indicates micro iris hooks were inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, or sector iridotomy with suture repair of iris sphincter.
    • Use H21.221-H21.223 if the operative note indicates permanent intraocular suture or a capsular support ring was employed to place the IOL in a stable position.
    • Use H21.531-H21.533 if the operative note indicates a capsular support ring was employed or an endocapsular support ring was used to partially occlude the pupil.
    • Use E08.36, E09.36, E10.36, E11.36, E13.36, H21.81, H21.89, H21.9, H22, H25.031-H25.033, H25.041-H25.043, H25.10-H25.13, H25.89, H25.9, H26.001-H26.003, H26.041-H26.043, H26.051-H26.053, H26.011-H26.013, H26.031-H26.033, H26.061-H26.063, H26.09, H26.101-H26.103, H26.121-H26.123, H26.30-H26.33, H26.8, H28, Q13.0, or Q13.2 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
    • Use H25.011-H25.013, H25.811-H25.813, H25.89 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
    Or, when Trypan Blue or isocyanine green is employed to enhance visualization:
    • Use H25.89 if the operative note indicates a diagnosis of mature cataract and dye was used to stain the anterior capsule.
    • Use H25.20, H25.21, H25.22, or H25.23 with H40.89, phacolytic glaucoma or dye staining of the anterior capsule.
    • Use H26.111-H26.113, H26.131-H26.133, if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular suture or a capsular support ring was employed.
    • Use H26.20 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, IOL implant was supported by using permanent intraocular sutures, a capsular support ring was employed, or a primary posterior capsulorrhexis was performed.
    • Use H28 if the operative note or postoperative records indicate an extraordinary amount of work was involved in the preoperative or postoperative care.
    • Use H27.10, H27.111-H27.113, H27.121-H27.123, H27.131-H27.133, Q12.1, Q12.2, Q12.4, or Q12.8 if the operative note indicates the IOL was supported by using permanent intraocular sutures or a capsular support ring was employed.
    • Use H57.00-H57.04, H57.051-H57.053, H57.09 or H57.9 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
    • Use Q13.1 if the operative note indicates the IOL was supported in the eye by using permanent intraocular sutures, a capsular support ring was employed or an endocapsular ring was used to partially occlude the pupil.