The H35.3211 Diagnosis Code is a critical component of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) system. Specifically, it pinpoints Exudative age-related macular degeneration, right eye, with active choroidal neovascularization. This code is essential for medical professionals, especially when dealing with ophthalmological diagnoses and billing processes. Understanding the nuances of H35.3211 is crucial for accurate record-keeping and ensuring appropriate patient care.
Decoding H35.3211: Exudative Age-Related Macular Degeneration
H35.3211 is a highly specific code within the broader category of age-related macular degeneration (AMD). Let’s break down each component of this diagnosis code:
- Exudative Age-Related Macular Degeneration: This refers to the “wet” form of AMD, a condition affecting the macula, the central part of the retina responsible for sharp, central vision. Exudative AMD is characterized by the abnormal growth of blood vessels under the retina, which leak fluid and blood, leading to rapid vision loss.
- Right Eye: The code clearly specifies that the condition is located in the patient’s right eye. This laterality is vital for accurate diagnosis and treatment planning, as AMD can affect one or both eyes.
- With Active Choroidal Neovascularization: This is the hallmark of exudative AMD. Choroidal neovascularization (CNV) describes the process where new, abnormal blood vessels originate from the choroid (the vascular layer beneath the retina) and grow into the retina. The term “active” indicates that this neovascularization is currently ongoing and contributing to the exudative process.
Billing and Application of the H35.3211 Code
From a medical coding and billing perspective, H35.3211 is a billable/specific code. This means it is recognized by insurance providers for reimbursement purposes when a patient is diagnosed with this specific condition. It’s important to note:
- Adult Patients: H35.3211 is applicable to adult patients, specifically those aged 15 to 124 years.
- Effective Date: The 2025 edition of ICD-10-CM, which includes H35.3211, became effective on October 1, 2024. The code itself was initially introduced in 2017, highlighting its relevance in contemporary medical classifications.
- Code History: Since its introduction in 2017, H35.3211 has remained unchanged through the 2025 ICD-10-CM update, indicating its established and consistent use in medical diagnosis coding.
Furthermore, H35.3211 falls under Diagnostic Related Group(s) (MS-DRG v42.0), which provides a framework for classifying hospital cases and determining standardized reimbursement.
Related ICD-10-CM Codes for Macular Degeneration
To provide context, here are some ICD-10-CM codes adjacent to H35.3211, representing related conditions and variations of age-related macular degeneration:
- H35.3210: Exudative age-related macular degeneration, right eye, stage unspecified.
- 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.
- H35.3221: Exudative age-related macular degeneration, left eye, with active choroidal neovascularization.
- H35.3231: Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization.
These codes, along with others in the H35.32 series, allow for precise classification of AMD based on the type (exudative vs. nonexudative), laterality (right eye, left eye, bilateral), and the presence and activity of choroidal neovascularization.
Conclusion
The H35.3211 diagnosis code is more than just a classification; it represents a specific and serious eye condition requiring accurate diagnosis and timely intervention. For healthcare providers, especially those specializing in ophthalmology and medical coding, a thorough understanding of H35.3211 and its related codes is paramount for effective patient management and compliant billing practices. This detailed code ensures that exudative age-related macular degeneration in the right eye with active choroidal neovascularization is precisely documented and addressed within the healthcare system.
