The ICD-10 code range H25-H28 pertains to disorders of the lens, encompassing a variety of conditions including age-related cataract, other cataract, aphakia and other disorders of lens. These codes are used to document lens disorders in patient records, insurance claims, and public health statistics. They provide a standardized way to represent the diagnosis and treatment of these conditions and are crucial for reimbursement, research, and health policy.

Key Usage Points:

•H25 is used for age-related cataract, subdivided by type and eye affected.
•H26 represents other types of cataract, including those caused by drugs or trauma.
•H27 includes disorders such as aphakia and dislocation of lens.
•H28 is used for lens disorders in diseases classified elsewhere.
•Always code to the highest level of specificity.

Coding Guidelines

When to Use:

✓When a patient is diagnosed with an age-related cataract.
✓When a patient has a cataract due to trauma or drug use.
✓When a patient is diagnosed with aphakia or lens dislocation.
✓When a patient has a lens disorder due to a disease classified elsewhere.

When NOT to Use:

✗When a patient has a suspected but unconfirmed lens disorder.
✗When a patient has a lens disorder due to a disease not classified elsewhere.
✗When a patient's lens disorder is not the primary reason for the encounter.
✗When a patient's lens disorder has been previously treated and no longer exists.

Code Exclusions

Always cross-check the patient's medical history and current symptoms to ensure accurate coding.

Documentation Requirements

Proper documentation for lens disorders should clearly state the type of disorder, the cause if known, and the eye affected. It should also include information on the severity of the condition, the impact on the patient's vision, and the treatment plan.

Clinical Information:

•Type of lens disorder
•Cause of the disorder, if known
•Eye affected (right, left, or both)
•Severity of the condition
•Treatment plan

Supporting Evidence:

•Visual acuity test results
•Slit-lamp examination findings
•Imaging results, if applicable
•Notes from ophthalmologist or optometrist

Good Documentation Example:

Patient diagnosed with age-related nuclear cataract in the right eye. Visual acuity reduced to 20/50. Plan for cataract surgery in 6 weeks.

Poor Documentation Example:

Patient has cataract.

Common Documentation Errors:

⚠Not specifying the type of cataract
⚠Not indicating the eye affected
⚠Not documenting the cause of the disorder
⚠Not detailing the treatment plan

Range Statistics

Total Codes

Billable

Complexity:

Medium

Primary Use:Clinical Documentation

Chapter:

Coding Complexity

Medium

Complexity Rating

Coding for lens disorders requires a good understanding of ophthalmology and the different types of lens disorders. The coder must also be able to determine the cause of the disorder and the eye affected, which can add to the complexity.

Key Factors:

▸Understanding the different types of cataracts and other lens disorders
▸Knowing when to use codes for lens disorders in diseases classified elsewhere
▸Determining the cause of the lens disorder, if applicable
▸Identifying the eye affected

Specialty Focus

These codes are primarily used by ophthalmologists and optometrists, but may also be used by primary care physicians and geriatricians when dealing with age-related eye conditions.

Primary Specialties:

Ophthalmology

60%

Optometry

30%

Primary Care

10%

Clinical Scenarios:

• A 65-year-old patient presents with blurred vision and is diagnosed with an age-related cataract.
• A patient with a history of steroid use develops a posterior subcapsular cataract.
• A patient presents with sudden vision loss and is diagnosed with a dislocated lens.
• A patient with diabetes develops a cataract, coded under H28.

Resources & References

Resources for coding lens disorders include the ICD-10-CM Official Guidelines for Coding and Reporting, the American Academy of Ophthalmology (AAO), and coding handbooks and training materials.

Official Guidelines:

ICD-10-CM Official Guidelines for Coding and Reporting
American Academy of Ophthalmology (AAO) Guidelines
World Health Organization (WHO) ICD-10 Browser

Clinical References:

AAO EyeWiki
National Eye Institute (NEI) Information on Eye Diseases and Disorders

Educational Materials:

ICD-10-CM Coding Handbook
Online coding courses and webinars

Frequently Asked Questions

How do I code for a patient with cataracts in both eyes?

If a patient has cataracts in both eyes, use separate codes for each eye. For example, H25.031 for age-related nuclear cataract in the right eye and H25.032 for the left eye.