Cracking the Code

Coding Cataracts

A cataract is an abnormal progressive condition of the lens of the eye characterized by loss of transparency. A yellow, brown, or white opacity can be observed within the lens, behind the pupil, according to Mosby’s Medical Dictionary. Cataracts occur naturally with age but can occur secondary to trauma, foreign bodies, disease, or drugs. If a cataract impedes vision sufficiently, surgery can be performed to remove the crystalline lens, and an artificial intraocular lens (IOL) can be placed.

 

When coding cataracts, we do not want to make assumptions about the type of cataracts based on the patient’s age or other conditions. A cataract in an older patient is not always senile or mature.  We want to be aware of the terminology used in the diagnostic statement. ICD-10-CM presumes a causal relationship between diabetes and cataracts. This is based on the “linkage” in the Alphabetic Index by the sub-terms “with” and “in”. Coding of diabetes and cataracts should be coded as related even in the absence of provider documentation explicitly linking them.

Q: What ICD-10-CM code(s) are reported for bilateral cataracts?
A: H26.9 Rationale: In the ICD-10-CM Alphabetic Index we look for ‘Cataract’ that refers us to the default code H26.9. Modifiers are not appended to diagnosis codes. There is no documentation to support that the cataracts are congenital. Even though the cataract is in both eyes, it is only necessary to report the ICD-10-CM code once per ICD-10-CM guideline I.B.12.
Reference: FY 2022 ICD-10-CM Coding Guidelines, AHA Coding Handbook, Mosby’s Medica Dictionary
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