Coding Macular Degeneration – A Common Age-related Eye Condition

An eye problem can occur at any time. Some eye problems occur with age, while others may be linked to other serious conditions. In most cases, people ignore the early signs of vision problems, hoping that their eyesight will improve on its own. Macular Degeneration is an eye disease that primarily affects the retina and destroys your sharp, central vision. Also called age-related macular degeneration (AMD), the condition is caused by the deterioration of the small central portion of the retina – called macula (the inside back layer of the eye). The macula records the images we see and sends them via the optic nerve from the eye to the brain. It controls our ability to read and view objects in fine details. When the cells of the macula deteriorate, images are not received correctly. In the early stages, macular degeneration does not affect vision. However, if the disease progresses to an advanced stage, people may experience blurred vision and if the condition worsens or reaches its final stages, central vision may be completely lost. Ophthalmologists who provide treatments to patients need to know the various types of macular degeneration. To code the diagnosis and treatments correctly, they can rely on reputable medical coding companies.

Macular degeneration is a leading, common cause of severe, permanent vision loss in people above 60 years or older. According to reports from the American Macular Degeneration Foundation (AMDF), the condition affects about 10 million people in the United States – more than cataracts and glaucoma combined. AMD usually occurs in both eyes, but the degree of involvement can vary between the two eyes. Adopting a healthy lifestyle and conducting regular comprehensive eye exams by an eye health professional can help detect AMD before the disease causes vision loss. Treatment modalities can slow down vision loss, but does not restore vision.

Types and Stages of AMD

Age-related macular degeneration (AMD) is of two different types –

• Dry AMD – Regarded as a common type, dry AMD occurs when parts of the macula get thinner with age and tiny yellow deposits of protein (called drusen) grow in the macula. It is estimated that about 80 percent (8 out of 10) of people who suffer AMD have the dry form. In this type, you may have blind spots in the center of your vision and as that get worse, you may lose central vision.
• Wet AMD – Regarded as a less common but more serious type, wet AMD occurs when new abnormal vessels grow under the retina. These blood vessels leak blood and fluid into your retina resulting in distorted vision. Bleeding from the blood vessels eventually forms a scar, leading to permanent loss of central vision.

Stages of AMD

There are three stages of Age-related Macular Degeneration (AMD) –

• Early AMD – In this early stage, people do not experience any kind of vision loss. That is why it is important to perform regular eye exams.
• Intermediate AMD – In this stage, there may be some amount of vision loss, without any specific noticeable symptoms. A comprehensive eye exam at this stage can help identify drusen or pigment changes in the retina.
• Late AMD – At this stage, complete vision loss may be noticeable.

In most cases, people realize that they have AMD only when their vision becomes very blurry. That is why it is important to have regular visits to an ophthalmologist as he/she can detect the reasons for early signs of AMD before a person encounters any vision problems.

Symptoms and Risk Factors

As mentioned above, people may not experience any noticeable signs and symptoms of macular degeneration in its early stages. The symptoms may not get diagnosed until the condition gets worse or affects both the eyes. Some of the common symptoms include –

• Dark, blurry areas in the center of your vision
• Worse or less clear vision (Vision may get blurry and it may be difficult for a person to read fine print or drive)
• Rarely, worse or different color perception

If a person experiences any of these symptoms or a combination of any of these, it is important to consult an ophthalmologist as early as possible. One of the biggest risk factors associated with the condition is age. Other additional risk factors include – smoking, a family history of AMD, high blood pressure, being overweight and consuming a diet high in saturated fat.

Diagnosing and Treating Different Types of AMD

Diagnosis of this eye condition will begin with a detailed eye exam, particularly the retina. Ophthalmologists will look for tiny yellow deposits called “drusen” under the retina, which is an early sign of the disease. As part of the eye exam, the ophthalmologist will ask patients to look at an “Amster Grid” – a pattern of straight lines (like a check board) which helps identify any specific blurry, distorted or blank spots in their field of vision. The ophthalmologist will also look inside the eye through a special lens to study if there are changes in the retina and macula. Dilating eye drops may be used to widen the pupil, as this allows the ophthalmologist to look through a special lens at the inside of the eye. Other screening tests include – fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). An early diagnosis will help ophthalmologists initiate treatment at the right time.

There is no specific cure for this eye condition, but administering certain treatment modalities may help slow the progression of symptoms and keep patients from experiencing severe loss of vision. Treatment options include laser therapy, photodynamic laser therapy, anti-angiogenic drugs and low vision aids. All diagnoses, screening and treatment procedures must be carefully documented using the correct medical codes. Billing and coding services offered by established medical billing and coding companies can ensure the correct codes on the medical claims. “Age-related macular degeneration bilateral icd-10 codes include:”

H35.3 Degeneration of macula and posterior pole

• H35.30 Unspecified macular degeneration
  • H35.31 Non-exudative age-related macular degeneration
    • H35.311 Non-exudative age-related macular degeneration, right eye
      • H35.3110 Non-exudative age-related macular degeneration, right eye, stage unspecified
      • H35.3111 Non-exudative age-related macular degeneration, right eye, early dry stage
      • H35.3112 Non-exudative age-related macular degeneration, right eye, intermediate dry stage
      • H35.3113 Non-exudative age-related macular degeneration, right eye, advanced atrophic without sub-foveal involvement
      • H35.3114 Non-exudative age-related macular degeneration, right eye, advanced atrophic with sub-foveal involvement
    • H35.312 Non-exudative age-related macular degeneration, left eye
      • H35.3120 Non-exudative age-related macular degeneration, right eye, stage unspecified
      • H35.3121 Non-exudative age-related macular degeneration, right eye, early dry stage
      • H35.3122 Non-exudative age-related macular degeneration, right eye, intermediate dry stage
      • H35.3123 Non-exudative age-related macular degeneration, right eye, advanced atrophic without sub-foveal involvement
      • H35.3124 Non-exudative age-related macular degeneration, right eye, advanced atrophic with sub-foveal involvement
    • H35.313 Non-exudative age-related macular degeneration, bilateral
      • H35.3130 Non-exudative age-related macular degeneration, bilateral, stage unspecified
      • H35.3131 Non-exudative age-related macular degeneration, bilateral, early dry stage
      • H35.3132 Non-exudative age-related macular degeneration, bilateral, intermediate dry stage
      • H35.3133 Non-exudative age-related macular degeneration, bilateral, advanced atrophic without sub-foveal involvement
      • H35.3134 Non-exudative age-related macular degeneration, bilateral, advanced atrophic with sub-foveal involvement
    • H35.319 Non-exudative age-related macular degeneration, unspecified eye
      • H35.3190 Non-exudative age-related macular degeneration, unspecified eye, stage unspecified
      • H35.3191 Non-exudative age-related macular degeneration, unspecified eye, early dry stage
      • H35.3192 Non-exudative age-related macular degeneration, unspecified eye, intermediate dry stage
      • H35.3193 Non-exudative age-related macular degeneration, unspecified eye, advanced atrophic without sub-foveal involvement
      • H35.3194 Non-exudative age-related macular degeneration, unspecified eye, advanced atrophic with sub-foveal involvement
  • H35.32 Exudative age-related macular degeneration
    • H35.321 Exudative age-related macular degeneration, right eye
      • H35.3210 Exudative age-related macular degeneration, right eye, stage unspecified
      • H35.3211 Exudative age-related macular degeneration, right eye, with active choroidal neovascularization
      • H35.3212 Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization
      • H35.3213 Exudative age-related macular degeneration, right eye, with inactive scar
      • H35.322 Exudative age-related macular degeneration, left eye
      • H35.3220 Exudative age-related macular degeneration, left eye, stage unspecified
      • H35.3221 Exudative age-related macular degeneration, left eye, with active choroidal neovascularization
      • H35.3222 Exudative age-related macular degeneration, left eye, with inactive choroidal neovascularization
      • H35.3223 Exudative age-related macular degeneration, left eye, with inactive scar
  • H35.323 Exudative age-related macular degeneration, bilateral
    • H35.3230 Exudative age-related macular degeneration, bilateral, stage unspecified
    • H35.3231 Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization
    • H35.3232 Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization
    • H35.3233 Exudative age-related macular degeneration, bilateral, with inactive scar
    • H35.329 Exudative age-related macular degeneration, unspecified eye
    • H35.3290 Exudative age-related macular degeneration, unspecified eye, stage unspecified
    • H35.3291 Exudative age-related macular degeneration, unspecified eye, with active choroidal neovascularization
    • H35.3292 Exudative age-related macular degeneration, unspecified eye, with inactive choroidal neovascularization
    • H35.3293 Exudative age-related macular degeneration, unspecified eye, with inactive scar

Even though people rarely lose all of their sight from age-related macular degeneration (AMD), they may experience poor central vision. With the severe form of AMD (either wet or dry AMD), the patient’s central vision may decrease to less than 20/200 in both eyes. However, in some cases, even after you get treatment for wet AMD, the condition can come back. Therefore, it is important for patients to test their level of vision on a regular basis and follow the instructions of their ophthalmologist (particularly patients who are above 50 years). The earlier one gets a diagnosis of AMD, the greater will be the chance that treatment will help.

Ophthalmology medical billing and coding can be challenging. Accurate clinical documentation of causes, types, symptoms and other procedures is vital to ensure accuracy in coding and billing. An experienced medical billing company can help physicians assign the right medical codes for this condition, and ensure optimal reimbursement.

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Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.
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