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H35.81
ICD-10-CM
Retinal Edema

Find comprehensive information on retinal edema diagnosis, including clinical documentation, medical coding (ICD-10, H35.8), and treatment options. Learn about macular edema, diabetic macular edema, and other related conditions. Explore symptoms, causes, and risk factors of retinal edema. Access resources for healthcare professionals on proper documentation and coding for accurate reimbursement. Discover the latest advancements in retinal edema management and patient care.

Also known as

Macular Edema
Retinal Swelling

Diagnosis Snapshot

Key Facts
  • Definition : Fluid buildup in the retina, causing swelling and blurred vision.
  • Clinical Signs : Blurry or distorted vision, seeing flashes of light, decreased visual acuity.
  • Common Settings : Diabetes, macular degeneration, retinal vein occlusion, uveitis, eye surgery.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC H35.81 Coding
H35.81

Retinal edema

Swelling of the retina due to fluid buildup.

H35.0-

Background retinopathy and retinal vascular changes

Non-inflammatory retinal changes affecting blood vessels.

H47.1-

Macular edema and retinopathy

Fluid accumulation affecting the central retina (macula).

H31.8-

Other retinal disorders

Encompasses various retinal conditions not specified elsewhere.

Code-Specific Guidance

Decision Tree for

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

Is the retinal edema due to diabetes?

  • Yes

    Nonproliferative retinopathy?

  • No

    Due to hypertension?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Retinal swelling from fluid leakage.
Diabetic macular edema
Macular edema following cataract surgery

Documentation Best Practices

Documentation Checklist
  • Retinal edema diagnosis: Laterality (OD, OS, OU)
  • Document edema location (e.g., macular, diffuse)
  • Severity: Mild, moderate, or severe
  • Etiology of retinal edema if known
  • Symptoms: Blurred vision, visual distortion

Coding and Audit Risks

Common Risks
  • Laterality Coding Errors

    Incorrect or missing laterality (right, left, bilateral) for retinal edema impacts reimbursement and data accuracy. ICD-10-CM coding guidelines require specifying laterality.

  • Underlying Cause Unspecified

    Failing to code the underlying etiology (e.g., diabetes, hypertension) with retinal edema leads to inaccurate severity reflection and potential claim denials. CDI crucial for specificity.

  • Macular vs. Non-Macular Confusion

    Distinguishing macular edema (H35.32) from other retinal edema types (H35.31) is critical for accurate coding, affecting treatment and resource allocation. Precise documentation needed.

Mitigation Tips

Best Practices
  • Document edema type, laterality, severity for accurate ICD-10 coding (H35.82).
  • Use precise clinical terms like macular edema, cystoid macular edema for CDI, SNOMED CT.
  • Capture etiology (e.g., diabetes, vein occlusion) for proper HCC risk adjustment.
  • Timely follow-up documented for monitoring response to treatment ensures compliance.
  • Image findings (OCT, fundus photography) support diagnosis, justify treatment, improve CDI.

Clinical Decision Support

Checklist
  • Confirm visual acuity changes, blurring, or distortion documented.
  • Verify OCT imaging confirms retinal thickening or fluid.
  • Check medical history for diabetes, hypertension, or vein occlusion.
  • Document fluorescein angiography findings if performed.
  • Assess and document impact on visual field if applicable.

Reimbursement and Quality Metrics

Impact Summary
  • Retinal Edema reimbursement hinges on accurate ICD-10 H35.8 coding and proper documentation of laterality, severity, and etiology for maximum payment.
  • Quality metrics for Retinal Edema track visual acuity improvements, OCT findings, and patient-reported outcomes, impacting hospital quality scores.
  • Timely diagnosis coding and treatment initiation for Retinal Edema minimizes claim denials and improves patient outcomes and hospital revenue cycle.
  • Coding diabetic macular edema as H36.0 instead of H35.8 impacts reimbursement and quality reporting tied to diabetes management programs.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code laterality: H57.01/H57.02
  • Macular edema: H35.32
  • Document cause, severity
  • Exclude cystoid: H35.8
  • Diabetic retinopathy: E10-E14

Documentation Templates

Patient presents with complaints consistent with retinal edema, including blurred vision, distorted vision, and metamorphopsia.  Visual acuity assessment revealed [insert visual acuity measurements for both eyes, e.g., 20/40 OD, 20/30 OS].  Amsler grid testing demonstrated [describe Amsler grid findings, e.g., central scotoma in the right eye].  Fundoscopic examination revealed [describe findings, e.g., retinal thickening, hard exudates, macular edema in the [right/left/both] eye(s)].  Optical coherence tomography (OCT) imaging confirmed the presence of retinal thickening and fluid accumulation within the retina, consistent with the diagnosis of retinal edema.  Etiology of the retinal edema is suspected to be [state suspected cause, e.g., diabetic retinopathy, retinal vein occlusion, uveitis, Irvine-Gass syndrome] based on [state supporting evidence, e.g., history of diabetes, presence of neovascularization, inflammatory signs].  Differential diagnoses considered included [list relevant differential diagnoses, e.g., epiretinal membrane, macular hole].  Treatment plan includes [describe treatment plan, e.g., observation, focal laser photocoagulation, anti-VEGF injections, topical or systemic corticosteroids] and close monitoring of visual acuity and retinal thickness with follow-up OCT in [specify timeframe, e.g., 4 weeks]. Patient education provided regarding the condition, its potential complications such as permanent vision loss, and the importance of adherence to the prescribed treatment plan.  ICD-10 code [insert appropriate ICD-10 code, e.g., H35.821, H35.822, H35.823] assigned.