A cataract is a clouding of the normally clear lens of your eye. The article provides an overview of this eye condition along with the medical codes.

1. Documenting Cataracts with
ICD-10 and CPT Codes
A cataract is a clouding of the normally clear lens of your eye. The
article provides an overview of this eye condition along with the
medical codes.
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A cataract is a cloudy area that forms in the lens of the eye that significantly
affects vision. Regarded as the main cause of vision loss among people
above 40 years of age, cataract begins when proteins in the eye form
clumps that prevent the lens from sending clear images to the retina. The
retina works by converting the light that comes through the lens into signals.
It sends the signals to the optic nerve, which carries them to the brain.
Generally, cataracts develop slowly and do not interfere with your eyesight
early on. It can occur in one or both eyes but won't spread like an infection
from one eye to the other. However, with passing years, the eye condition
will significantly interfere with your vision. Initially, stronger lighting and
eyeglasses can help you deal with cataracts. Cataract surgery may be
required in extreme cases if the vision interferes with your day-to-day
activities. Proper clinical documentation is important to help medical
coding service providers assign the correct medical codes for appropriate
reimbursement.
According to the National Eye Institute, more than half of people in the
United States have cataracts or have undergone cataract surgery by the
time they reach 80 years old. It is estimated that about 40 percent of US
people aged 65 years or above have some degree of lens clouding. Any
person can develop a cataract, as age is one of the most predominant risk
factors. Aging or injury changes the tissues that make up your eye's lens.
Other underlying causes include – genetic disorders, an overproduction of
oxidants (oxygen molecules), habit of smoking, long-term exposure to bright
sunlight, long-term use of steroid medications, previous eye
inflammation/injury/surgery, diseases like diabetes and exposure to ionizing
radiation.

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Types of Cataracts
All cataracts are fundamentally a change in the clarity of the overall lens
structure. However, in some cases, cataracts may occur either early in life or
as a result of aging. Cataract types include -
 Nuclear cataract – Typically associated with aging, this type forms
deep in the central zone (nucleus) of the lens.
 Sub capsular cataract – This type of cataract occurs at the back of
the lens. People with diabetes or those taking high doses of steroid
medications have a greater risk of developing this condition.
 Cortical cataract – These are wedge-shaped opacities or streaks that
form on the outer edge of the lens cortex.
 Congenital cataract – This type of cataract may be present at birth
or form during a baby’s first year.
 Traumatic cataract – This type develops soon after an injury to the
eye, but it can take several years for this to happen.
What Are the Typical Symptoms?
In most cases, cataracts take years to develop and they tend to appear in
older age. As the condition develops slowly, most people do not know the
exact causes. However, as the lens clouding progresses, the vision gradually
gets worse. Long-distance vision is more severely affected at the beginning.
Cataracts often affect both the eyes, but rarely equally. Common symptoms
include –
 Blurry vision
 Trouble seeing at night
 Increased sensitivity to glare
 Halos surrounding lights
 Double vision in the affected eye

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 Need for frequent changes in prescription glasses
 Need for brighter light for reading and other activities
 Fading or yellowing of colors
 Double vision in a single eye
During the initial stages of the cataract growth, the cloudiness in your vision
may affect only a small part of the eye’s lens. In such cases, people may be
quite unaware about the vision loss. However, as the cataract grows larger,
it clouds more of your lens and distorts the light passing through the lens.
Diagnosing and Treating Cataracts
Initial diagnosis of this eye condition will begin with a comprehensive eye
exam to check for cataracts and to assess your vision. This will include an
eye chart test to check your level of vision at different distances. In addition,
Tonometry test will be conducted to adequately measure your eye pressure.
This test uses a painless puff of air to flatten your cornea and test your
degree of eye pressure. Ophthalmologists will also put drops in your eyes to
make your pupils bigger. This makes it easier to check the optic nerve and
retina at the back of your eye for damage. In addition, several other tests
like - Visual acuity test, Slit-lamp examination and Retinal exam are used to
measure the level of vision.
When symptoms of this eye condition begin to appear, your ophthalmologist
or eye specialist may ask you to wear stronger eyeglasses, magnifying
lenses, or sunglasses with an anti-glare coating. Surgery will be considered
as a last resort when cataracts prevent you from going about your daily
activities, such as reading or driving. It’s also performed when cataracts
interfere with the treatment of other eye problems. Surgery to remove a
cataract is generally safe and has a high success rate.

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Cataract surgery may be of two different types. Phacoemulsification involves
the use of ultrasound waves to break the lens apart and remove the pieces.
Extra-capsular surgery on the other hand, involves removing the cloudy part
of the lens through a long incision in the cornea. After surgery, an artificial
intraocular lens is placed where the natural lens was positioned. Most people
can go home the same day after the surgery.
Ophthalmology medical coding involves using ICD-10-CM and CPT codes
for reporting cataracts on your medical claims.
ICD-10 Codes
H25 - Age-related cataract
 H25.0 - Age-related incipient cataract
 H25.1 - Age-related nuclear cataract
 H25.2 - Age-related cataract, morgagnian type
 H25.8 - Other age-related cataract
 H25.9 - Unspecified age-related cataract
H26 - Other cataract
 H26.0 - Infantile and juvenile cataract
 H26.1 - Traumatic cataract
 H26.2 - Complicated cataract
 H26.3 - Drug-induced cataract
 H26.4 - Secondary cataract
 H26.8 - Other specified cataract
 H26.9 - Unspecified cataract
H27 - Other disorders of lens
 H27.0 - Aphakia
 H27.1 - Dislocation of lens

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 H27.8 - Other specified disorders of lens
 H27.9 - Unspecified disorder of lens
H28 - Cataract in diseases classified elsewhere
CPT Codes
 92273 - Electroretinography (ERG), with interpretation and report; full
field
 92274 - Electroretinography (ERG), with interpretation and report;
multifocal
 0509T - Electroretinography (ERG) with interpretation and report;
pattern (PERG)
 0514T - Intraoperative visual axis identification using patient fixation
(list separately in addition to code for primary procedure)
If left untreated, cataracts can interfere with your day-to-day activities and
in some cases lead to blindness. Even though surgical removal of cataracts is
a highly effective procedure, there are several other techniques that can be
followed to prevent the occurrence of this eye condition in the long run.
These prevention tips include – conducting regular eye examinations,
quitting the habit of smoking, wearing sunglasses (that block UV radiation),
eating fruits and vegetables that contain antioxidants and keeping diabetes
and other medical conditions in control.
Choosing the correct medical codes from a huge list of codes can be difficult,
unless the coder has a clear idea about the same. For accurate and timely
medical billing and claims submission, opthalmology practices can consider
outsourcing their medical coding tasks to a professional medical billing
and coding company that provides the services of AAPC-certified coding
specialists.