What is the ICD‑10‑CM (International Classification of Diseases, 10th Revision, Clinical Modification) code for cataract?

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ICD-10-CM Code for Cataract

The ICD-10-CM coding system does not use a single universal code for "cataract" - you must specify the type, laterality (right/left/bilateral), and stage of cataract to assign the correct code. The codes fall primarily in the H25 and H26 series.

Primary Code Categories

Age-Related Cataracts (H25 series)

  • 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 (includes cortical and subcapsular)
  • H25.9: Unspecified age-related cataract

Other Cataracts (H26 series)

  • 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

Critical Coding Requirements

Each code requires a 6th character to specify laterality:

  • 1 = Right eye
  • 2 = Left eye
  • 3 = Bilateral
  • 9 = Unspecified eye

For example:

  • H25.11 = Age-related nuclear cataract, right eye
  • H25.12 = Age-related nuclear cataract, left eye
  • H25.13 = Age-related nuclear cataract, bilateral

Clinical Documentation Needed

To code accurately, documentation must specify:

  • Type: Nuclear, cortical, posterior subcapsular (PSC), or mixed 1
  • Laterality: Which eye(s) affected
  • Etiology: Age-related vs. traumatic vs. drug-induced vs. congenital
  • Stage: Incipient (early) vs. mature vs. hypermature

Common Pitfall

Never use H25.9 or H26.9 (unspecified codes) when clinical documentation provides specific information about cataract type and location - this results in lost specificity and potential reimbursement issues. The increased granularity of ICD-10-CM compared to ICD-9-CM requires precise documentation 2, 3.

Most Frequently Used Codes in Practice

Based on cataract surgery patterns, the most commonly assigned codes are:

  • H25.13: Age-related nuclear cataract, bilateral (most common surgical indication) 1
  • H25.813/H25.823: Cortical and subcapsular cataracts with laterality specified
  • H26.9: Only when documentation is truly insufficient to specify type

References

2
Research

ICD-9-CM to ICD-10-CM Codes: What? Why? How?

Advances in wound care, 2013

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.