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ICD-10 Guide
DiagnosesAphakia

Aphakia

ICD-10 Coding for Aphakia(H27.00, H27.01, H27.02, H27.03)

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

Diagnosis Overview

What is Aphakia?
Essential facts and insights about Aphakia

Key Clinical Considerations:

  • Presence of visual impairment or loss of vision due to absence of the lens of the eye.
  • Patient history indicating previous cataract surgery or trauma leading to lens removal.
  • Physical examination findings such as aphakic eye appearance and lack of lens reflex.
  • Diagnostic tests showing absence of the lens on slit-lamp examination.
  • Severity criteria include the degree of visual impairment measured by visual acuity tests.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical record must document the diagnosis of aphakia with specific details of the condition.
  • Terminology such as 'aphakia', 'lens absence', or 'post-cataract surgery' must be used.
  • Examples include: 'Patient diagnosed with aphakia following cataract extraction.'
  • Documentation must establish medical necessity for any surgical or corrective interventions.
  • Quality measures may include visual acuity assessments and follow-up care documentation.

Coding Guidelines

Usage Guidelines & Examples

  • Use H27.00 for unspecified aphakia, H27.01 for aphakia following cataract surgery, H27.02 for aphakia due to trauma, and H27.03 for aphakia due to other causes.
  • Do not use these codes for patients with pseudophakia (presence of an artificial lens).
  • Similar codes include H25 (age-related cataract) and H26 (other cataracts), but these do not denote lens absence.
  • Common errors include misclassifying aphakia as pseudophakia; ensure lens status is accurately documented.
  • In complex cases, consider the patient's surgical history and any co-existing ocular conditions.

Code Exclusions

Important Exclusions

  • Excludes pseudophakia, which is the presence of an artificial lens.
  • Alternative codes for pseudophakia include H27.1 (pseudophakia).
  • Conditions are excluded to ensure accurate representation of lens status.
  • Common mistakes include coding aphakia when the patient has a lens implant.
  • Related but distinct conditions include lens dislocation and other refractive errors.

Related ICD-10 Codes

Primary Codes
H27.00
Aphakia, unspecified
H27.01
Aphakia following cataract surgery
H27.02
Aphakia due to trauma
H27.03
Aphakia due to other causes
Differential Codes
Q12.3

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Ophthalmology

Specialty Applications

  • Applies to patients with a history of cataract surgery or ocular trauma.
  • Patient populations include all ages, with higher prevalence in older adults.
  • Clinical settings include outpatient ophthalmology clinics and inpatient surgical units.
  • Specialty-specific applications are primarily in ophthalmology and optometry.
  • Treatment contexts include corrective lenses, contact lenses, or surgical interventions.

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 aphakia based on clinical findings of lens absence.'

Template 2

Template: 'Clinical presentation consistent with aphakia including significant visual impairment.'

Template 3

Template: 'Diagnostic criteria for aphakia met as evidenced by absence of lens on examination.'

Template 4

Template: 'Treatment plan initiated for aphakia with corrective lenses prescribed.'

Template 5

Template: 'Follow-up care for aphakia including monitoring of visual acuity and adjustment of lenses.'

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?

Documentation must include the diagnosis, clinical findings, and any surgical history.

How does this differ from similar diagnoses?

Aphakia is characterized by the absence of the lens, while pseudophakia indicates the presence of an artificial lens.

What are common billing considerations?

Ensure that the diagnosis is clearly documented to support medical necessity for corrective measures.

What procedures are typically associated?

Commonly associated procedures include cataract extraction and lens implantation.

Are there any quality reporting implications?

Quality measures may include tracking visual acuity outcomes and follow-up care compliance.