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ICD-10 Guide
DiagnosesAge Related Macular Degeneration

Age Related Macular Degeneration

ICD-10 Coding for Age-Related Macular Degeneration(H35.31x1, H35.31x3, H35.32x2)

PRIMARY SPECIALTYOphthalmology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Age Related Macular Degeneration?
Essential facts and insights about Age-Related Macular Degeneration

Key Clinical Considerations:

  • Presence of drusen (yellow deposits under the retina) observed during fundoscopic examination.
  • Symptoms may include blurred vision, difficulty seeing in low light, and a central blind spot (scotoma).
  • Visual acuity tests may reveal decreased vision in affected individuals.
  • Optical coherence tomography (OCT) may show retinal pigment epithelium changes and fluid accumulation.
  • Severity can be classified into early, intermediate, and late stages based on the extent of retinal damage and visual impairment.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Document the presence of specific symptoms and clinical findings related to AMD.
  • Use precise terminology such as 'dry AMD' or 'wet AMD' to describe the condition.
  • Examples include noting the size and number of drusen and any changes in visual acuity.
  • Medical necessity must be established through documentation of symptoms and the impact on daily activities.
  • Quality measures may include tracking visual acuity changes and adherence to treatment protocols.

Coding Guidelines

Usage Guidelines & Examples

  • Use H35.31x1 for early dry AMD and H35.31x3 for late dry AMD with geographic atrophy.
  • Do not use these codes for non-age-related macular degeneration conditions such as diabetic retinopathy.
  • H35.32x2 is used for wet AMD, which requires different management and treatment approaches.
  • Common errors include misclassifying the type of AMD or failing to document the stage of the disease.
  • In complex cases, ensure to document all relevant findings and consider comorbid conditions that may affect coding.

Code Exclusions

Important Exclusions

  • Excludes conditions such as diabetic retinopathy (E11.359) and retinal detachment (H33.0).
  • Alternative codes for excluded conditions should be used to ensure accurate billing.
  • Conditions are excluded due to differing pathophysiology and treatment protocols.
  • Common mistakes include using AMD codes for non-age-related conditions.
  • Related but distinct conditions include central serous retinopathy and other retinal dystrophies.

Related ICD-10 Codes

Primary Codes
H35.31
Dry age-related macular degeneration, stage unspecified
H35.32
Wet age-related macular degeneration
Ancillary Codes
Z00.00
H54.7
Z51.11
Differential Codes
H35.32x1
H35.31x4
H35.31x1

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Ophthalmology

Specialty Applications

  • Primarily affects older adults, typically over the age of 50.
  • Higher prevalence in individuals with a family history of AMD, smokers, and those with cardiovascular disease.
  • Clinical settings include outpatient ophthalmology clinics and inpatient eye care facilities.
  • Specialty-specific applications are relevant in ophthalmology and optometry.
  • Treatment contexts include monitoring progression and managing interventions such as anti-VEGF injections.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with age-related macular degeneration based on clinical findings of drusen and decreased visual acuity.'

Template 2

Template: 'Clinical presentation consistent with dry AMD including blurred vision and presence of drusen.'

Template 3

Template: 'Diagnostic criteria for AMD met as evidenced by OCT findings showing retinal pigment epithelium changes.'

Template 4

Template: 'Treatment plan initiated for wet AMD with anti-VEGF injections and follow-up scheduled.'

Template 5

Template: 'Follow-up care for AMD including monitoring visual acuity and retinal health.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Document clinical findings such as visual acuity, presence of drusen, and any symptoms experienced by the patient.

How does this differ from similar diagnoses?

AMD is primarily age-related, while other conditions like diabetic retinopathy are linked to diabetes.

What are common billing considerations?

Ensure that the diagnosis is supported by clinical findings and that the correct stage of AMD is documented.

What procedures are typically associated?

Common procedures include optical coherence tomography (OCT) and fluorescein angiography.

Are there any quality reporting implications?

Quality measures may include tracking visual acuity changes and adherence to treatment protocols.