Coding is the common language that allows ophthalmology clinicians, insurance companies, and government agencies to share and understand information about a patient’s health.
Diagnoses are classified with ICD-10 codes, while procedures are classified using CPT codes. ICD-10 stands for the 10th revision of the International Classification of Diseases, created and maintained by the World Health Organization.
There are ICD-10 codes for ophthalmological diseases, symptoms, complaints, causes of eye injury, and social circumstances affecting a patient’s care.
Most eye health practitioners use ICD-10-CM codes, which apply in outpatient and clinical settings. Some may also use ICD-10-PCS codes, which are used in inpatient and hospital environments.
Proper coding enables providers and payers to understand the patient’s medical history. Clinical registries, such as the IRIS Registry, use codes to track public health data.
Changes to ICD-10 for 2025
The World Health Organization updates its list of codes annually. The 2025 changes to the ICD-10 took effect on Oct. 1, 2024.
This year’s changes included:
- 324 new CM codes
- 36 deleted CM codes
- 14 revised CM code descriptions, including descriptions for degenerative myopia
ICD-10 Codes Commonly Used in Ophthalmology
As one might guess, there are many ICD-10 codes related to the health of a patient’s eyes. Here are some common codes every coder in your ophthalmology practice should be familiar with. (This list is representative only and not intended to be comprehensive.)
Routine Eye Exam Codes |
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The ICD-10 code for a routine eye exam depends on whether the exam turns up anything abnormal. The primary category for an eye exam is Z (examination), 01 (exam without complaint or diagnosis).
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Eye Pain Codes |
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The code for pain in or around the eye is categorized as H (diseases of the eye and adnexa), 57 (other disorders).
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Corneal Abrasion Codes |
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When treating a patient for a corneal abrasion with no foreign body remaining in the eye, the code changes slightly depending on the number of previous visits. Corneal abrasion is categorized as S (injuries or other external causes), 05 (injury of eye and orbit).
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Vitreous Hemorrhage Codes |
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Vitreous hemorrhage is categorized as H (diseases of the eye and adnexa), 43 (disorders of the vitreous body).
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Senile Entropion Codes |
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To properly code a diagnosis involving the eyelid, the clinician must note not only which eye is affected, but whether the issue affects the upper or lower lid. Senile entropion is categorized as H (diseases of the eye and adnexa), 02 (other disorders of the eyelid).
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Diabetic Cataract Codes |
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When coding eye disorders caused by diabetes, it’s important to note the type of diabetes. Diabetic cataracts are categorized as E (a condition with external cause).
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Age-Related Cataract Codes |
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Age-related cataracts have a category all to themselves: H (diseases of the eye and retina), 25 (age-related cataract).
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Gonococcal Infection of the Eye Codes |
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Gonococcal infections are categorized as A (infectious diseases), 54 (predominantly sexual mode of transmission).
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Horseshoe Tear of the Retina Without Detachment Codes |
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A horseshoe tear of the retina is categorized as H (diseases of the eye and adnexa), 33 (retinal detachments and breaks).
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Glaucoma Codes – Open Angle With Borderline Findings, Low Risk |
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Glaucoma is categorized as H (diseases of the eye and adnexa), 40 (glaucoma. When the diagnosis is open angle with borderline findings, low risk, the code specifies which eye is affected.
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Squamous Blepharitis Codes |
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Squamous blepharitis is categorized as H (diseases of the eye and adnexa), 02 (other disorders of the eyelid). Though there is a code for “unspecified,” clinicians should note for coders not only which eye is affected, but which eyelid. Coding impacts insurance payments and Medicare reimbursement, so the more specific and accurate the coding, the better the practice’s cash flow.
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Macular Degeneration Codes |
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Macular degeneration is categorized as H (diseases of the eye and adnexa), 35 (other retinal disorders).
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Refractive Error Codes |
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Refractive errors are categorized as H (diseases of the eye and adnexa), 52 (disorders of refraction and accommodation).
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Common Coding Errors for Ophthalmology Practices to Avoid
Accurate medical coding is crucial to operating a successful ophthalmology practice. Incorrect coding is one of the primary reasons insurers deny claims. This can lead to costly delays in reimbursement, slowing the revenue cycle.
Avoid these common mistakes to keep claims moving smoothly:
1. Allowing staff training to lapse
The ICD-10 is updated regularly. As we noted above, 36 CM codes that were available for use in 2023 won’t be valid in 2025 – and more than 300 codes that didn’t exist a year ago are now on the books.
Keep your staff’s training up to date. This helps them perform at a higher level, which benefits the business.
Investing in staff training also engages employees and lets them know the clinic cares about them and their careers – important factors in employee satisfaction and retention.
2. Not being specific in coding
Review many common ophthalmology codes in ICD-10 and you’ll note a pattern: The code changes based on which eye and which part of the eye is affected.
Coding to the highest level of specificity possible helps payers understand the patient’s condition.
To achieve this, establish practices that emphasize complete documentation and clear communication between clinical and billing staff.
3. Consolidating diagnoses and services
When multiple decisions are made or services are performed in the same visit, it can lead to another common coding error.
A simple example is an exam with abnormal findings. The exam, the diagnosis, any treatment delivered, and any follow-up prescribed are all coded separately in the claim.
Clinicians can help with this by being very specific as they enter information into the ophthalmology EHR, noting everything that occurred in the visit.
4. Misusing modifiers
Modifiers are codes that append to standard codes to indicate special circumstances. They should be used with discretion.
Be prepared to be challenged on the use of modifiers, and be sure you have the documentation to justify them.
5. Not taking advantage of automation
Your ophthalmology EHR can be one of your greatest tools in improving coding accuracy.
During the patient visit, automated tools prefill information, reducing the documentation burden on clinicians without leaving off important details. As the clinician enters their notes, prompts ensure coders will have the specificity they need.
Besides facilitating communication with clinic staff, the EHR helps coders perform their tasks more efficiently.
An ophthalmology-specific practice management system prioritizes the codes relevant to the specialty, making it easy for staff to find and verify the codes they need without wading through chapters on skin disorders or musculoskeletal conditions.
The tool’s built-in checks ensure diagnoses and services are coded correctly and that nothing was improperly consolidated.
Improve Coding Efficiency at Your Ophthalmology Practice
Nextech’s ophthalmology-specific EHR and practice management system creates and supports an efficient workflow between clinic and billing staff.
Advanced automation reduces the risk of manual errors. The system includes automatic checks and validation and is always up to date with the latest guidelines.
In addition, you’ll enjoy less paperwork, better patient engagement, and data you can use to make strategic business decisions.
Efficient coding boosts your clinic’s productivity, reduces claims denials, and improves your revenue cycle management. Schedule a demo to see what Nextech can do for you.