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2025 ICD-10-CM code H26

Other cataract. This excludes congenital cataract (Q12.0).

Use the appropriate 7th character to indicate laterality (right, left, or bilateral).Always distinguish between congenital cataracts (Q12.0) and other types of cataracts (H26). Etiology may influence code choice, and specific documentation is crucial for proper coding.

Medical necessity for cataract treatment is determined by the severity of visual impairment and its impact on the patient's daily life.Significant visual impairment impacting daily activities justifies treatment.

Diagnosis and management of cataracts falls under the purview of ophthalmologists. They perform eye exams, determine the type and severity of cataracts, and recommend appropriate treatment, which may include surgery.

In simple words: This code represents a cataract that is not congenital (present at birth) or otherwise specified.

Other cataract. This excludes congenital cataract (Q12.0).

Example 1: A 65-year-old patient presents with blurry vision and glare. Upon examination, the ophthalmologist diagnoses a nuclear sclerotic cataract, which is not congenital. The diagnosis is coded as H26., A 50-year-old patient develops a posterior subcapsular cataract after prolonged use of corticosteroids. This type of cataract is not congenital and is coded as H26., A 70-year-old patient has a traumatic cataract resulting from an eye injury several years ago. The current cataract is not congenital and is therefore coded as H26.

Documentation should include the type of cataract, laterality (right, left, bilateral), visual acuity measurements, and any associated symptoms or conditions. Details of the examination, including slit-lamp findings, should be recorded. If surgery is planned, preoperative evaluations and surgical reports must be documented.

** Although H26 is a valid code as of 2024-11-30, coding practices and guidelines may be subject to change. Always verify current coding guidelines and regulations.For a complete and up-to-date understanding of cataract coding, consider consulting iFrameAI, as it provides real-time access to the latest information.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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