ICD-10-CM and CPT coding for age-related macular degeneration

September 11th, 2018

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains age-related macular degeneration from a coding perspective, focusing on diagnosis reporting and the major treatment categories discussed in ophthalmology. It is aimed at coders, billers, and eye care staff who need a high-level understanding of how the condition is documented and how related services are categorized in ICD-10-CM, CPT, and HCPCS. The article also covers general documentation and coverage considerations tied to these services.

Why This Topic Matters

Age-related macular degeneration is a common cause of vision loss, and accurate coding matters for diagnosis reporting, treatment claims, and payer review. Understanding the article helps readers identify which coding systems and procedure types are addressed before reviewing the full premium guidance.

Article Sections

  1. Types of age-related macular degeneration (AMD)

    Introduces the main forms of the condition and places them in a broader clinical context. The section supports later discussion of diagnosis reporting and treatment categories.

  2. Risk factors

    Summarizes broad patient and lifestyle factors associated with the condition. This section provides background context for the overall topic.

  3. Diagnosing AMD

    Describes common eye examination methods and imaging approaches used when evaluating the condition. The section focuses on the diagnostic workup discussed in the article.

  4. ICD-10-CM coding for AMD

    Explains the diagnosis-coding portion of the article, including how the condition is organized in the ICD-10-CM system. It also notes the broad distinctions used in the article for reporting different forms of AMD.

  5. Treatments for AMD

    Provides an overview of treatment approaches discussed for both major forms of the disease. This section serves as the bridge between diagnosis coding and procedure coding.

  6. Dry AMD

    Summarizes the supportive treatment approach described for the dry form of the condition. It sets up later coding discussion by distinguishing this pathway from the wet AMD treatment sections.

  7. Wet AMD

    Introduces treatment approaches discussed for the wet form of the disease. The section focuses on the service categories that follow in the article.

  8. Intravitreal VEGF therapy

    Covers the injection-based therapy discussion and related billing concepts. The section also includes the article’s example of documentation and claim handling for this treatment category.

  9. Ocular photodynamic therapy

    Discusses the photodynamic therapy service category and the related coding framework presented in the article. The section includes the encounter-based example described by the author.

  10. Implantable miniature telescope

    Reviews the implantable telescope treatment discussed for advanced disease. The section includes the associated example showing how the service is represented in the article.

What You Will Learn

  • How the article organizes age-related macular degeneration into clinical and coding topics
  • Which coding systems are discussed for diagnosis and treatment reporting
  • How the article frames the major treatment categories for the condition
  • What kinds of documentation and coverage considerations are mentioned
  • Which specialty and payer-related references appear in the discussion

Who Should Read This

  • Medical coders
  • Ophthalmology billing staff
  • Eye care practices
  • Coding educators
  • Revenue cycle staff

Codes Discussed

  • ICD-10-CM: H35.31-
  • ICD-10-CM: H35.3111
  • ICD-10-CM: H35.32-
  • ICD-10-CM: H35.30
  • ICD-10-CM: H35.3211
  • ICD-10-CM: H35.3231
  • ICD-10-CM: H35.3114
  • ICD-10-CM: H35.3124
  • CPT: 67028
  • CPT: 67221
  • CPT: 67225
  • CPT: 0308T
  • HCPCS Level II: C9257
  • HCPCS Level II: J0178
  • HCPCS Level II: J2503
  • HCPCS Level II: J2778
  • HCPCS Level II: J9035
  • HCPCS Level II: J3396
  • HCPCS Level II: C1840

Code Ranges Discussed

  • ICD-10-CM: H35.31-
  • ICD-10-CM: H35.32-

Modifiers Discussed

  • CPT: -LT
  • CPT: -RT
  • CPT: -50

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