Eye issues can happen at any time. Some eye issues are brought solely by aging, while others might be related to more severe illnesses. Most of the time, individuals overlook the warning signals of vision issues in the hope that they would go away on their own.

Your clear, center vision will be lost if you have macular degeneration, an eye condition that predominantly impacts the center part of the retina. The disorder, also known as age-related macular degeneration (AMD), is brought on by the degradation of the macula, a tiny central area of the retina (the inside back layer of the eye). 

The macula captures the pictures we view and transfers them from the eye to the brain through the optic nerve. It regulates how well we can read and see small details on items. Images are received blurry as the macula’s cells degenerate.

Macular degeneration does not impair vision in its early stages. However, if the illness develops or reaches its ultimate stages, central vision may be entirely lost. People may also have impaired vision if the disease advances to an advanced degree.

Ophthalmologists who treat patients must be familiar with the many forms of macular degeneration. They are able to count on trustworthy medical coding businesses to accurately record the diagnosis and treatments. 

Macular degeneration is the primary, most frequent cause of severe, lifelong vision loss in those aged 60 and older. The ailment, which is more common than cataracts and glaucoma combined, affects around 10 million individuals in the US, according to statistics from the American Macular Degeneration Foundation (AMDF).

AMD often affects both eyes, however, there might be differences in how much each eye is affected. Adopting a healthy lifestyle and having routine, thorough eye exams performed by an eye care specialist can help diagnose AMD before the condition results in vision loss. While there are treatment options available, eyesight cannot be restored. 

AMD Types and Stages 

Two main kinds of age-related macular degeneration (AMD) exist. 

Dry AMD

Dry AMD is a kind of AMD that is widespread and is brought on by the macula developing little, yellow protein deposits known as drusen as it ages. About 80% (8 out of 10) of those who have AMD are thought to have the dry variety. The middle portion of your vision may have blind spots with this kind, and if they worsen, you risk losing it altogether. 

Wet AMD

Wet AMD is regarded as a less frequent but more dangerous form of the disease and develops when new abnormal blood vessels develop beneath the retina. Your retina is affected by these blood vessels’ leakage of blood and fluid, which distorts your vision. Blood vessel bleeding eventually creates a scar, which results in a permanent loss of central vision. 

Age-related macular degeneration (AMD) has three stages: 

Early AMD

People do not feel any form of visual loss at this early stage. Therefore, it is crucial to get frequent eye exams. 

Intermediate AMD

AMD at the intermediate stage may cause some degree of vision loss, but there are no other obvious symptoms. At this point, drusen or pigmentary changes in the retina can be found with the assistance of a thorough eye exam. 

Late AMD

Complete visual loss may be apparent at this point. 

Most of the time, people only become aware that they have AMD when their vision gets noticeably hazy. Because an ophthalmologist can identify the causes of early indicators of AMD before a person experiences any vision issues, it is crucial to visit them frequently. 

Risk factors and Symptoms 

People may not detect any early symptoms or indicators of macular degeneration, as was previously indicated. It’s possible that the problem won’t be detected until the symptoms worsen or both eyes are affected. Some of the typical signs include: 

• parts of your eyesight that are dark and fuzzy 
• worsening or lessening of eyesight (Vision may get blurry and it may be difficult for a person to read fine print or drive) 
• Rarely, color perception might be poorer or different. 

It is crucial to see an ophthalmologist as soon as possible if a person exhibits any of these symptoms alone or in combination. Age is one of the main risk factors for the illness. Smoking, having a family history of AMD, having high blood pressure, being overweight, and eating a diet heavy in saturated fat are some additional risk factors. 

Identifying and Treating the Various Forms of AMD 

A thorough eye exam, focusing on the retina, will be the first step in the diagnosis of this eye ailment. Drusen, which are microscopic yellow deposits under the retina and are an early indicator of the illness, are something that ophthalmologists will check for.

 The ophthalmologist will ask patients to examine an “Amsler Grid” as part of the eye examination. This grid of straight lines, which resembles a checkerboard, helps detect any specific blurry, distorted, or blank places in the patient’s field of vision. 

The retina and macula will also be examined by the ophthalmologist using a special lens to determine whether there have been any changes to them. To enable the ophthalmologist to view the inside of the eye through a specific lens, dilating eye drops could be used to enlarge the pupil. Fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography are further screening procedures (OCTA). Ophthalmologists can start therapy at the appropriate moment with the aid of an early diagnosis. 

Although there is no known therapy for this eye disease, using particular methods of care may assist individuals to avoid suffering from significant vision loss and reduce the severity of their symptoms.

Low vision aids, photodynamic laser therapy, anti-angiogenic medications, and laser therapy are all available as treatments. The proper medical codes must be used to precisely document all diagnostic, screening, and therapeutic operations. The right codes on the medical claims may be ensured by using the billing and coding services provided by reputable medical billing and coding firms. The following are the ICD-10 diagnostic codes for various forms of AMD:

AMD (ICD 10 macular degeneration) Coding for Laterality 

You must use the sixth character to indicate laterality when using ICD 10 codes for macular degeneration, dry AMD (H35.31xx), and wet AMD (H35.32xx) as follows: 

• In the right eye, 1 
• The left eye, 2 
• For bilateral, 3 

Tip: Regardless of whether one or both eyes are being treated, use the bilateral designation (3) if the same disease stage is present in both eyes. 

Which eye is being treated should be indicated by the treatment  ICD 10 code for macular degeneration.

Coding for AMD Dry Staging (dry macular degeneration ICD 10)

The staging is indicated by the seventh character in the dry AMD codes (H35.31xx) as follows: 

H35.31×1 for early dry AMD, which includes abnormalities of the retinal pigment epithelium (RPE), a few tiny drusen ( 63 m), a few intermediate drusen (> 63 m and 124 m), or both. 

H35.31×2 for AMD’s dry Intermediate stage

—at least 1 huge drusen ( 125 mm) or vast intermediate drusen (> 63 mm and 124 mm). 

Geographic atrophy (GA) excluding subfoveal involvement in advanced atrophic dry AMD is coded as H35.31×3. 

H35.31×4 for subfoveal involvement in advanced atrophic dry AMD—GA affecting the fovea’s center.

Dry Age-Related Macular Degeneration (Table 1) (AMD) 

Key:  7th position denote staging, whereas the 6th position denotes laterality.

Geographic Atrophy: Definition 

When does a retina become atrophic? GA is outlined as follows in The Academy Preferred Practice Pattern1: 

The late form of non-neovascular AMD known as central geo­graphic atrophy will have one or more clearly defined zones of RPE and/or chorio­capillaris atrophy. The atrophic regions may be surrounded by drusen and other pigmentary abnormalities. 

Those with geographic atrophy experience severe visual acuity loss less frequently and more gradually than patients with neovascular AMD. However, around 10% of all AMD-related vision loss of 20/200 or worse is due to geographic atrophy of the foveal center. Patients with geographic atrophy, which does not always affect the central fovea, may have relatively high distant visual acuity but exhibit a significantly reduced capacity for close-up tasks like reading.   According to reports, 50% of individuals with geographic atrophy over the course of two years experience a doubled visual angle.   Also possible is choroidal neovascularization. 

Geographic Atrophy Coding 

The Academy advises indicating if the GA impacts the foveal center when coding: If it does, code H35.31×4; if it doesn’t, code H35.31×3, where “x” denotes laterality. Better categorization of GA will aid clinical management and also result in greater comprehension of the disease’s natural history, comorbidities, and visual prognosis. 

When there is no approved therapy, why use a diagnostic code?

Researchers and decision-makers will be able to follow the visual impairment and visual function deficiencies that are connected to the disorder with the use of accurate recording and classification. Furthermore, you will be equipped to code for therapies when they do become accessible. 

Prognosis

The risk of vision loss increases when the macula is involved, however even in GA patients without subfoveal involvement, visual function issues might occur. Regarding the prognosis of GA patients, the Academy Basic and Clinical Science Course makes the following observations: 

The fovea is frequently spared by GA until the illness is already advanced. Around the fovea, it may first manifest as one or more irregular atrophy patches. The ability to do tasks like reading is hampered by these patches as they expand, consolidate, and may be accompanied by a thick paracentral scotoma. GA patients may have fair visual acuity (VA) until late in the disease’s progression, when the fovea gradually atrophies, causing severe central blindness and necessitating the patient to read and do other visual activities using noncentral retina and eccentric fixation. 

Atrophy may not always occur in every eye with drusen or PED, although it does seem to be more common as people become older. 10% of AMD patients with a visual acuity of 20/200 or below have GA, while 12 to 20% of GA patients have significant vision loss.

Wet Age-Related Macular Degeneration (Table 2) (AMD) 

Key: Laterality is shown in the sixth position, and staging in the seventh position.

Staging Coding for Wet AMD (wet macular degeneration ICD 10)

The sixth character of the wet AMD code, H35.32xx, denotes laterality, and the seventh character denotes staging. 

H35.32×1 for active choroidal neovascularization (CNV), which entails either (1) an AMD-related CNV lesion that exhibits disease activity (i.e., the presence of intraretinal fluid [IRF] or subretinal fluid [SRF]) and contributes to the patient’s visual impairment or (2) an AMD-related CNV lesion that does not exhibit disease activity (i.e., no IRF or SRF) in the presence of 

H35.32×2 for inactive CNV refers to a CNV lesion associated with AMD that no longer exhibits disease activity (i.e., no IRF/SRF) and is a factor in the patient’s vision loss. 

An AMD-related CNV lesion that has developed into a disciform scar and is causing visual impairment is described in H35.32×3 for an inactive scar. Given the underlying disciform scar, the CNV lesion may or may not exhibit disease activity (i.e., IRF/SRF), although it is regarded as aesthetically unimportant. 

Wet AMD definitions for inactive CNV (H35.2×2) and inactive scar (H35.2×3). The lack of IRF or SRF is what the Academy refers to as “inactive CNV” for the purposes of these ICD-10 classifications. After being diagnosed with inactive CNV, the same eye, however, may develop active CNV, at which point therapeutic options may be considered. Similarly, an eye with an inactive scar may develop active CNV following the diagnosis of an inactive scar, at which point therapeutic options may be examined.

Conclusion

Using the right ICD 10 code for age-related macular degeneration will help insure proper reimbursement and aid in the documentation of the disease process. It will make it easier to identify what stage the disease is in and which eye or eyes are affected and to what degree.