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H30.002

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🧬ICD-10 CM H30.002 - Focal chorioretinal inflammation, left eye

Overview

ICD-10 CM H30.002 classifies Focal chorioretinal inflammation localized to the left eye. This condition involves inflammation of both the choroid (the vascular layer of the eye) and the retina in a specific, limited area (focal) rather than being disseminated or widespread. It is a form of posterior uveitis.

Accurate coding of H30.002 is essential for documenting ocular inflammation, tracking disease progression, and supporting medical necessity for diagnostic imaging (e.g., OCT, Fluorescein Angiography) and treatments (e.g., corticosteroids, immunosuppressive therapy). Laterality must be specified whenever possible.

Code Breakdown

The structure of H30.002 follows the ICD-10-CM taxonomy:

SegmentValueDescription
CategoryH30Chorioretinal inflammation
SubcategoryH30.0Focal chorioretinal inflammation
ExtensionH30.00Focal chorioretinal inflammation, unspecified eye
Laterality2Left eye

Laterality Specifics

  • 1: Right eye
  • 2: Left eye
  • 3: Bilateral
  • 0: Unspecified eye (Use only if documentation does not specify)

Laterality Requirement

ICD-10-CM guidelines emphasize specifying laterality for eye conditions whenever known. If the medical record indicates the left eye is affected, use H30.002. If bilateral, use H30.003. Avoid unspecified codes (H30.009) when clinical documentation supports specificity.

Coding Guidelines

Includes

  • Focal chorioretinitis.
  • Focal choroiditis with retinitis.
  • Localized inflammation of the choroid and retina.
  • Posterior uveitis (when specified as focal chorioretinal inflammation).

Excludes

  • Disseminated Chorioretinal Inflammation: H30.1 (If the inflammation is widespread rather than focal).
  • Posterior Cyclitis: H30.2.
  • Chorioretinal Scars: H32.8 (If the condition is inactive/scarring rather than active inflammation).
  • Syphilitic Chorioretinitis: A52.7 (Code first the underlying syphilis).
  • Tuberculous Chorioretinitis: A18.5 (Code first the underlying tuberculosis).
  • Toxoplasmosis: B58.01- (Code first the underlying toxoplasmosis).
  • Congenital Toxoplasmosis: P37.1.

Use of Additional Codes

H30.002 may be coded with additional codes to fully capture the clinical picture:

  • Infectious Agent: If the inflammation is due to a specific infectious organism, use additional codes from B95-B97 (e.g., B95.61 for Methicillin susceptible Staph aureus).
  • Associated Systemic Disease: If associated with a systemic condition (e.g., sarcoidosis D86.9, Behcet’s Disease M35.2, Rheumatoid Arthritis M06.9), code the underlying condition first or as secondary depending on the reason for encounter.
  • Visual Impairment: If the condition has resulted in vision loss, add codes from H54.- (e.g., H54.10 for severe vision impairment).
  • Medication Use: If the patient is on long-term steroids for treatment, consider Z79.52 (Long term (current) use of steroids).
  • Glaucoma: If secondary glaucoma is present, add codes from H40.- or H42.-.

Risk Adjustment (HCC)

Hierarchical Condition Category (HCC) status determines impact on risk adjustment scores for Medicare Advantage and ACA plans.

  • HCC Status: No CMS-HCC V28
  • RAF Impact: This code does not directly contribute to the Risk Adjustment Factor (RAF) score under the current CMS-HCC V28 model.
  • Clinical Relevance: While not an HCC, chronic chorioretinal inflammation indicates significant resource utilization (specialist visits, imaging, medications) and may trigger care management programs due to the risk of vision loss.

Inpatient Impact (MS-DRG)

In the inpatient setting, H30.002 influences the Medicare Severity Diagnosis Related Group (MS-DRG) assignment.

  • CC/MCC Status: Non-CC (Not a Complication/Comorbidity) CMS MS-DRG v42
  • Impact: This code generally does not shift a DRG to a higher severity tier on its own. However, it supports medical necessity for admissions related to severe complications (e.g., retinal detachment, secondary glaucoma) or intravenous treatment initiation.
  • POA Indicator: Present on Admission (POA) reporting is required for inpatient claims.

Code Tree

Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
└── Disorders of choroid and retina (H30-H36)
    └── Chorioretinal inflammation (H30)
        └── Focal chorioretinal inflammation (H30.0)
            └── Focal chorioretinal inflammation, unspecified eye (H30.00)
                └── H30.001 (Right eye)
                └── H30.002 (Left eye)
                └── H30.003 (Bilateral)
                └── H30.009 (Unspecified eye)

Clinical Coding Examples

Example 1: Routine Follow-up

Scenario: A patient presents for follow-up of known focal chorioretinitis in the left eye. The inflammation is stable on current medication. Coding:

  • Primary: H30.002
  • Secondary: Z79.52 (Long term (current) use of steroids) - If applicable.

Example 2: Associated with Sarcoidosis

Scenario: Patient with systemic sarcoidosis presents with flare-up of focal chorioretinal inflammation in the left eye. Coding:

  • Primary: D86.9 (sarcoidosis, unspecified) - If managing the systemic condition.
  • Secondary: H30.002 (Focal chorioretinal inflammation, left eye)
  • Note: Sequence based on the reason for the encounter. If the visit is solely for the eye, H30.002 may be primary.

Example 3: Infectious Etiology

Scenario: Patient diagnosed with focal chorioretinitis in the left eye due to Toxoplasmosis. Coding:

  • Primary: B58.01 (Toxoplasma chorioretinitis)
  • Note: Do not use H30.002 when a specific etiology code exists that includes the eye condition. B58.01 is more specific.

Example 4: Bilateral Involvement

Scenario: Patient presents with focal chorioretinal inflammation in both eyes. Coding:

Revenue Cycle Considerations

  • wRVU: Not Applicable. ICD-10-CM codes do not have work Relative Value Units. wRVUs are assigned to CPT/HCPCS procedure codes.
  • Assistant Payable: Not Applicable. This attribute applies to surgical CPT codes.
  • Denial Risk: Moderate. Payers may deny claims if the level of service (E/M) does not support the complexity of managing uveitis, or if laterality is unspecified when exam data exists.
  • Prior Authorization: Medications used to treat chorioretinitis (e.g., biologics, steroids) and imaging (e.g., 92201 for Angiography) often require prior authorization supported by diagnosis codes like H30.002.
  • H30.001: Focal chorioretinal inflammation, right eye
  • H30.003: Focal chorioretinal inflammation, bilateral
  • H30.009: Focal chorioretinal inflammation, unspecified eye
  • H30.1: Disseminated chorioretinal inflammation
  • H30.20: Posterior cyclitis
  • H54.-: Visual impairmentb
  • B95-B97: Bacterial and viral infectious agents
  • D86.9: Sarcoidosis, unspecified

Clinical Management Notes

Management of H30.002 typically involves American Academy of Ophthalmology:

  • Corticosteroids: Topical, periocular, intravitreal, or systemic to reduce inflammation.
  • Immunosuppressive Therapy: For non-infectious uveitis refractory to steroids (e.g., methotrexate, biologics).
  • Antimicrobials: If an infectious etiology is identified (e.g., antibiotics, antivirals, antiparasitics).
  • Monitoring: Regular imaging (OCT, Fundus Photography) to monitor inflammation and detect complications like macular edema or neovascularization.

Documentation should support the medical necessity of these treatments when billing associated procedure codes (e.g., 67028 for intravitreal injection).

CMS ICD-10-CM Official Guidelines for Coding and Reporting FY 2025 CMS-HCC Risk Adjustment Model V28 Summary CMS MS-DRG Definitions Manual v42 NCHS ICD-10-CM Tabular List 2025 American Academy of Ophthalmology Preferred Practice Pattern

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