2025 ICD-10-CM code H26.9
(Active) Effective Date: N/A Diseases of the eye and adnexa - Disorders of lens 7 Feed
Unspecified cataract.
Medical necessity for intervention (such as cataract surgery) is based on the severity of visual impairment and its impact on the patient's daily life. Documentation should support the need for the intervention by describing the functional limitations caused by the cataract.
Diagnosis and management of cataracts falls under the purview of ophthalmologists.They are responsible for evaluating the patient's vision, determining the type and severity of the cataract, and recommending appropriate treatment, which may include surgery or other interventions.
In simple words: This code refers to a cloudy lens in the eye (a cataract) where the specific type is unknown.
This code is used when the type of cataract is not specified or documented. It includes cataracts that are not otherwise classified in the H25-H28 range.
Example 1: A 70-year-old patient presents with blurry vision. Upon examination, the ophthalmologist diagnoses a cataract, but the specific type is not documented, so H26.9 is used., A patient's medical record states "cataract" with no further details.In the absence of more specific information, H26.9 is the appropriate code., A patient has a history of cataracts and is experiencing worsening vision.If the documentation does not specify the type of cataract, H26.9 is used.
Documentation should include details about the patient's visual symptoms, the presence of a cataract confirmed through examination (e.g., slit-lamp biomicroscopy), and any associated conditions. If the type of cataract can be determined, it should be documented for more specific coding.
** Excludes1: congenital cataract (Q12.0)
- Payment Status: Active
- Specialties:Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center