Eye Exam ICD-10-CM Codes | 2023

What ICD-10 Codes are used for Eye Exams

ICD-10 codes for eye exams encompass a range of conditions and procedures related to ophthalmology. These codes are essential for accurate medical coding and billing. 

Here are the commonly used eye exams ICD-10 codes: 

• H25.9 - Unspecified age-related cataract: This code is used when a patient has a cataract, a clouding of the eye's lens, without specifying the age-related factor. It is a general code for cataracts without further classification.
• H52.1 - Myopia: Myopia refers to nearsightedness, a common refractive error where distant objects appear blurry. This code is utilized when documenting the presence of myopia during an eye examination.
• H53.9 - Unspecified visual disturbance: This code is applied when a patient experiences visual disturbances without a specific diagnosis. It is a broad code for general visual impairments that may require further evaluation.
• H35.31 - Nonexudative age-related macular degeneration, right eye: Nonexudative age-related macular degeneration (AMD) is a degenerative condition affecting the macula, leading to vision loss. This code specifies the state in the right eye.
• H40.9 - Glaucoma, unspecified: Glaucoma is a group of eye conditions characterized by optic nerve damage, often associated with increased intraocular pressure. This code is used for cases where glaucoma is diagnosed but not further classified.
• H10.9 - Conjunctivitis, unspecified: Conjunctivitis, or pink eye, is an inflammation of the conjunctiva. This code is employed when the specific type of conjunctivitis is not identified during the examination.
• H52.21 - Hypermetropia: Hypermetropia, or farsightedness, is a refractive error where distant objects are seen more clearly than close ones. This code is used to indicate the presence of hypermetropia.
• H26.9 - Unspecified cataract: Similar to H25.9, this code represents cataracts without specifying the age-related factor. It is a general code for unspecified cataracts.
• H33.9 - Retinal detachment, unspecified: Retinal detachment involves the separation of the retina from its normal position. This code is applied when the specific type or cause of retinal detachment is not identified.
• H10.43 - Chronic allergic conjunctivitis: Chronic allergic conjunctivitis is a persistent inflammation of the conjunctiva due to an allergic reaction. This code is used to specify the chronic nature of the condition.

These ICD-10 codes offer a systematic way to categorize and document various eye conditions encountered during examinations, facilitating proper medical coding and billing processes.

Which Eye Exam ICD Codes are billable

• H25.9 - Unspecified age-related cataract: Yes
• H52.1 - Myopia: Yes
• H53.9 - Unspecified visual disturbance:  Yes
• H35.31 - Nonexudative age-related macular degeneration, right eye: Yes
• H40.9 - Glaucoma, unspecified: Yes
• H10.9 - Conjunctivitis, unspecified: Yes
• H52.21 - Hypermetropia: Yes
• H26.9 - Unspecified cataract: Yes
• H33.9 - Retinal detachment, unspecified: Yes
• H10.43 - Chronic allergic conjunctivitis: Yes

ICD-10 codes for eye exams are billable with proper documentation. Accurate coding is essential for reimbursement, and detailed clinical documentation must be provided to support medical claims.

Additionally, the billability of a code may also depend on the specific requirements of insurance carriers or healthcare payers, so healthcare providers should be aware of and comply with those guidelines to ensure successful reimbursement.

Clinical information

• Eye exams serve a dual purpose: to assess visual acuity and monitor the eyes' overall health. They are crucial in identifying refractive errors, such as myopia or hypermetropia, and detecting eye conditions like glaucoma, cataracts, and macular degeneration.
• The recommended frequency of routine eye screenings varies based on individual factors, but generally, it is advised to have them every one to two years to detect potential issues early.
• Individuals may undergo eye exams for symptoms like blurred vision, strain, or discomfort. Those with chronic conditions such as diabetes may have specialized exams to monitor for retinopathy.
• Eye exams enable the early detection of eye diseases, enhancing the effectiveness of treatment. They also allow for preventive measures, such as recommending lifestyle changes or protective eyewear.
• Pediatric and geriatric eye exams address different conditions: pediatric exams detect and treat vision issues in children. In contrast, geriatric exams focus on age-related diseases such as cataracts and macular degeneration.
• Ophthalmologists can work with other healthcare providers for comprehensive care. For example, diabetic patients may need eye exams coordinated with endocrinologists, and certain conditions may require surgical referrals.

Synonyms include

• Vision Check
• Ophthalmic Examination
• Eye Evaluation
• Optometric Assessment
• Visual Health Inspection
• Ocular Examination
• Eye Health Assessment
• Optic Inspection
• Sight Examination
• Retinal Evaluation