Cataracts

Created Jun 2010
Reviewed Dec 2019

Query

Patient has documentation of posterior subcapsular and nuclear sclerosis cataract in the same eye.  I have been coding this to H25.1 Senile nuclear cataract as a progression of disease.

However, one of our ophthalmologists said that H25.8 Other senile cataract is more appropriate because of the inclusion term ‘combined forms of senile cataract’.  What is the intention of H25.8? Does it really include incipient cataracts along with mature?

Response

Refer to ACS 0701 Cataract for the definition and classification of cataract.

Cataract definition:
Cataracts are the opacity or loss of clarity of the crystalline lens.  They are classified according to a number of criteria including aetiology, morphology, age of onset, maturity, etc.

 Classification of cataract can be:

  1. Aetiological: Senile, traumatic, metabolic, toxic, secondary (complicated), maternal infection, maternal drug ingestion, hereditary, associated with syndromes (e.g. Down's syndrome)
  2. Morphological: Capsular (congenital or acquired), subcapsular (posterior or anterior), nuclear (congenital or senile), cortical (congenital or senile), lamellar, sutural
  3. According to maturity: Immature, mature, intumescent, hyper mature or morgagnian
  4. According to age of onset: Congenital, infantile, juvenile, presenile, and senile.

Cataract classification:
Unless the cataract is specified as senile, traumatic, drug-induced, etc assign H26.9 Cataract, unspecified. Attempt to obtain further specificity if possible.

The morphological classification of a senile cataract comprises three main types: subcapsular, nuclear or cortical, which describe where in the lens the opacity occurs. ‘Combined forms of senile cataract’ refers to any combination of these main types.

Classification of cataracts can also be based on maturity; and senile cataract ranges from incipient through to hypermature.  Note that a senile incipient cataract is not the same as an unspecified incipient cataract (‘incipient’ means ‘beginning to exist or appear’) – so the diagnosis codes for these are H25.0 Senile incipient cataract and H26.9 Cataract, unspecified respectively.

This query is about a senile cataract with combined subcapsular and nuclear lens opacity, therefore the correct code to assign is H25.8 Other senile cataract.  The intention of the code H25.8 Other senile cataract is to classify the cataract in terms of its morphology, and not according to its maturity.

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