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H34.10
ICD-10-CM
Central Retinal Artery Occlusion

Central Retinal Artery Occlusion (CRAO), also known as retinal artery occlusion, is a serious eye condition requiring immediate medical attention. Learn about CRAO diagnosis, treatment, ICD-10 codes, clinical documentation tips, and healthcare best practices for managing this ophthalmologic emergency. Find information on symptoms, risk factors, and prognosis for central retinal artery occlusion. This resource provides essential guidance for healthcare professionals, including ophthalmologists, neurologists, and emergency physicians, on accurate CRAO coding and documentation.

Also known as

CRAO
Retinal Artery Occlusion

Diagnosis Snapshot

Key Facts
  • Definition : Sudden, painless vision loss in one eye caused by blockage of the central retinal artery.
  • Clinical Signs : Pale retina, cherry-red spot on macula, afferent pupillary defect, markedly reduced visual acuity.
  • Common Settings : Emergency room, ophthalmology clinic, stroke center.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC H34.10 Coding
H34.0-H34.1

Occlusion of retinal artery

Blockage of retinal artery causing vision loss.

H54

Blindness and low vision

Covers various vision impairments, including from CRAO.

I63.0-I63.9

Cerebral infarction

Related as CRAO can be caused by emboli from stroke.

I70

Atherosclerosis

Atherosclerosis is a risk factor for CRAO.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the central retinal artery occlusion unilateral?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Sudden, painless vision loss in one eye.
Partial vision loss, often with flashing lights or floaters.
Painless, blurry vision, often with distorted images.

Documentation Best Practices

Documentation Checklist
  • Document CRAO symptoms (sudden, painless, unilateral vision loss)
  • Funduscopic exam findings: pale retina, cherry-red spot
  • Assess for emboli, atherosclerosis risk factors (e.g., hypertension)
  • Ischemic time documented, if known. Amaurosis fugax history?
  • Differential diagnosis considerations documented and ruled out

Coding and Audit Risks

Common Risks
  • Laterality Coding

    Missing or incorrect laterality (right, left, bilateral) for CRAO can impact reimbursement and data accuracy.

  • Underlying Cause

    Failure to code underlying conditions like giant cell arteritis or carotid artery disease with CRAO can affect severity.

  • Branch vs. Central

    Miscoding branch retinal artery occlusion (BRAO) as CRAO or vice versa leads to inaccurate reporting and payment.

Mitigation Tips

Best Practices
  • Timely diagnosis: Urgent ophthalmology consult for CRAO (ICD-10 H34.21)
  • Document visual acuity, pupillary reflexes, fundoscopy findings for CRAO
  • Ocular massage, anterior chamber paracentesis: Document CRAO management (CPT 92014)
  • Consider systemic evaluation for CRAO: cardiac, carotid Doppler (ICD-10 codes I70-I79)
  • CDI: Complete CRAO documentation supports accurate coding, risk adjustment

Clinical Decision Support

Checklist
  • Sudden, painless, unilateral vision loss: Documented?
  • Relative afferent pupillary defect: Checked?
  • Pale retina, cherry-red spot on funduscopy: Confirmed?
  • Consider emboli source (e.g., carotid artery): Evaluated?
  • Ischemic time documented for treatment decisions?

Reimbursement and Quality Metrics

Impact Summary
  • Central Retinal Artery Occlusion (CRAO) reimbursement hinges on accurate ICD-10 coding (H34.11, H34.12) and timely claim submission.
  • CRAO coding errors impact hospital case mix index (CMI) and overall revenue integrity.
  • Quality metrics for CRAO include time to thrombolytic therapy, impacting hospital performance reports and potential penalties.
  • Proper CRAO documentation supports medical necessity reviews and reduces claim denials, optimizing reimbursement.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Frequently Asked Questions

Common Questions and Answers

Q: What are the key differentiating features in the differential diagnosis of central retinal artery occlusion (CRAO) vs. branch retinal artery occlusion (BRAO)?

A: Differentiating between central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) relies on observing the affected area of the retina. In CRAO, the entire retina appears pale and edematous, with a cherry-red spot in the fovea due to preserved choroidal circulation. Vision loss is profound and often described as sudden, painless, and unilateral. In BRAO, the retinal whitening and edema are confined to the distribution of the affected arteriole, resulting in a more localized visual field defect. While CRAO typically presents with a complete afferent pupillary defect, BRAO often presents with a relative afferent pupillary defect depending on the severity. Fundus photography and fluorescein angiography can confirm the diagnosis and delineate the affected retinal area, aiding in the differentiation. Explore how incorporating optical coherence tomography angiography (OCTA) can enhance the visualization of retinal perfusion in CRAO and BRAO.

Q: What are the immediate management strategies and recommended treatments for acute central retinal artery occlusion to maximize potential vision recovery?

A: Time is of the essence in managing acute central retinal artery occlusion (CRAO). Immediate management focuses on restoring retinal blood flow. Interventions include ocular massage to dislodge emboli, anterior chamber paracentesis to lower intraocular pressure, and administration of carbogen (95% oxygen and 5% carbon dioxide) to induce vasodilation. Intravenous thrombolytics may be considered in selected cases within a narrow time window. Systemic evaluation to identify the underlying cause of CRAO, such as carotid artery disease, cardiac embolism, or vasculitis, is crucial. Consider implementing a standardized CRAO protocol that includes rapid assessment, initiation of ocular interventions, and prompt referral to a specialist for further management and long-term care. Learn more about emerging therapies like intra-arterial thrombolysis and neuroprotection strategies being explored for CRAO.

Quick Tips

Practical Coding Tips
  • Code H34.11 for CRAO
  • Document visual acuity loss
  • Specify laterality (left/right)
  • Query physician for etiology
  • Check for emboli documentation

Documentation Templates

Patient presents with acute painless vision loss in the right eye.  Onset was sudden this morning upon awakening.  Symptoms include profound visual impairment described as "like a curtain coming down".  Medical history includes hypertension and hyperlipidemia.  Ocular examination reveals marked visual acuity reduction to count fingers at 1 foot in the affected eye.  Afferent pupillary defect is present.  Funduscopic examination demonstrates a pale, edematous retina with a cherry-red spot in the macula.  Arterioles appear attenuated.  No emboli are visualized.  The left eye is unremarkable.  Assessment: Central retinal artery occlusion (CRAO) of the right eye. Differential diagnosis includes branch retinal artery occlusion (BRAO), ischemic optic neuropathy, and giant cell arteritis.  Given the sudden, painless monocular vision loss, pale retina, cherry-red spot, and attenuated arterioles, the diagnosis of CRAO is most likely.  Plan:  Immediate ophthalmology consultation.  Carotid ultrasound to evaluate for carotid artery stenosis.  Echocardiogram to assess for cardiac source of emboli.  Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to rule out giant cell arteritis.  Patient education provided regarding risk factors, potential for vision recovery, and importance of follow-up.  Treatment options including ocular massage and anterior chamber paracentesis will be considered by ophthalmology.  ICD-10 code H34.111, right eye central retinal artery occlusion, will be used for billing.  CPT codes for the examination and any procedures performed will be documented accordingly. Prognosis guarded.  Close monitoring and follow-up are essential.