Crystal's MCW Coder Hub🧬 ICD-10-CM H35.3110 — Nonexudative AMD, Right Eye, Stage Unspecified
Last-Resort Code — CDI Query Is Required First
H35.3110 is a valid, billable 7-character code — but it is a documentation deficiency indicator, not a clinical diagnosis category. It signals that AMD stage is either absent or indeterminate in the available documentation. Before assigning this code, you are required to:
- Review ALL available documentation — not just the discharge summary or impression; check office notes, consult reports, OCT reports, fundus photography interpretations, and nursing assessments
- Determine if staging criteria are clinically inferable from documented findings (drusen size, pigmentary changes, GA presence) even without explicit stage labeling — if so, assign the stage-specific code directly
- Submit a CDI query asking the physician to specify AMD stage when documentation is insufficient but the physician should be able to clarify [web:102]
- Only if stage remains indeterminate after steps 1-3 → assign H35.3110 as an interim code and flag for retrospective correction [web:103][web:104]
Billable Code Confirmed
H35.3110 is a valid, billable 7-character ICD-10-CM code for FY2025. [web:101] All seven characters are present:
H35(category) +.3(degeneration of macula) +1(nonexudative) +1(right eye) +0(stage unspecified). No additional characters required — this code will process on a claim. But billability ≠ appropriateness; use only when clinically and documentationally justified.
Non-Billable Parent Codes — Also Do Not Submit These
The following codes in the same family tree are non-billable headers (separate issue from stage unspecified):
- ❌
H35.311— 6-character header — missing staging character entirely- ❌
H35.31— 5-character header — missing laterality AND stagingH35.3110 (with the “0” staging character) is the only valid billable code for right-eye dry AMD when stage is truly undetermined. Do not submit the 6-character parent
H35.311.
🔍 Code Description
H35.3110 classifies nonexudative (dry) age-related macular degeneration of the right eye with stage unspecified — a diagnostic code used exclusively when the clinical stage of the AMD (early, intermediate, or advanced) cannot be determined from the available medical record documentation at the time of coding, despite thorough record review and, when feasible, a CDI query.1
The “stage unspecified” designation reflects a documentation deficiency, not a clinically distinct entity. There is no AMD patient who is truly “stage unspecified” from the treating physician’s perspective — every dilated fundus examination and OCT report contains objective findings (drusen size, pigmentary changes, geographic atrophy presence or absence) that establish stage. When H35.3110 is used, it means that information did not make its way into the documentation in a form available to the coder. The goal in every encounter is to resolve that gap — either by reading the full record more carefully, inferring stage from documented clinical findings, or querying the provider — before defaulting to the unspecified code. [web:104]
🌳 Code Tree / Hierarchy
H35.3 Degeneration of Macula and Posterior Pole
│
├── H35.31 Nonexudative AMD ❌ Non-billable header
│ │
│ └── H35.311 Right Eye ❌ Non-billable header
│ │
│ ├── H35.3110 Right eye, STAGE UNSPECIFIED ◀ THIS CODE ⚠️ LAST RESORT
│ ├── H35.3111 Right eye, early dry stage ✅ PREFERRED
│ ├── H35.3112 Right eye, intermediate dry stage ✅ PREFERRED
│ ├── H35.3113 Right eye, advanced atrophic, w/o subfoveal ✅ PREFERRED
│ └── H35.3114 Right eye, advanced atrophic, w/ subfoveal ✅ PREFERRED
The Stage Determination Hierarchy — Work Through This Before Assigning H35.3110
Before accepting “stage unspecified,” run through this decision tree:
Step 1: Does the record document drusen size or pigmentary changes?
- Only small drupelets (<63μm), no changes → NOT AMD → no H35.31xx code
- Medium drusen (≥63-<125μm), no pigment → H35.3111 Early
- Large drusen (≥125μm) or any pigment change → H35.3112 Intermediate
Step 2: Does the record document geographic atrophy?
- GA present, not subfoveal → H35.3113 Advanced, no subfoveal
- GA present, subfoveal → H35.3114 Advanced, subfoveal
Step 3: Does the physician use stage language anywhere in the full chart?
- “Early,” “mild,” “drusen only” → H35.3111
- “Intermediate,” “moderate,” “large drusen,” “AREDS2 started” → H35.3112
- “Geographic atrophy,” “advanced,” “GA” → H35.3113 or H35.3114 (query for subfoveal)
Step 4: Is a CDI query feasible before bill drop?
- Yes → Query → assign specific code per response
- No → H35.3110 interim → flag for retrospective correction
📊 When H35.3110 vs. Stage-Specific Codes — Decision Reference
| Situation | Correct Action | Code |
|---|---|---|
| Record documents drusen size AND stage labeled | Assign directly | H35.3111-H35.3114 |
| Record documents drusen size, no stage label | Infer stage from findings | H35.3111-H35.3114 |
| Record says “AMD, right eye” — no other detail | CDI query → assign per response | Query first; H35.3110 if no response before bill drop |
| Incomplete record at time of coding — consult pending | Interim H35.3110 + flag for retrospective correction | H35.3110 |
| Legacy record — no objective findings documented, no query possible | H35.3110 is appropriate | H35.3110 |
| Telehealth/screening read without staging detail | H35.3110 interim pending in-office follow-up | H35.3110 |
| Record documents AREDS2 supplementation — no stage | Infer intermediate AMD → query to confirm | H35.3112 after query, or H35.3110 interim |
| Physician documents “wet AMD” | Do NOT use H35.31xx — assign H35.3211 | H35.3211 |
AREDS2 Supplementation Is a Staging Clue
If the record documents that a patient is taking AREDS2 supplements but no AMD stage is explicitly stated, use that clinical clue to inform a query. AREDS2 is indicated for intermediate AMD (H35.3112) or advanced AMD in the fellow eye — it is NOT indicated for early AMD (H35.3111). A patient already on AREDS2 almost certainly has at least intermediate AMD. Do not assign H35.3110 without first querying to confirm intermediate staging when AREDS2 use is documented. [web:104]
✅ Includes
The following limited scenarios map to H35.3110 — right eye, stage unspecified:1
- Nonexudative AMD, right eye, stage not documented in available record
- Dry AMD, right eye, NOS — when stage cannot be determined from any available documentation source
- Age-related macular degeneration, right eye, nonexudative — stage indeterminate at time of coding
"NOS" Does Not Mean "Default" — It Means Documentation Exhausted
The clinical term “NOS” (not otherwise specified) in the context of H35.3110 means that the coder has exhausted available documentation sources and cannot determine the stage. It does NOT mean H35.3110 is the default code for AMD when you haven’t checked the full record. The ICD-10-CM Official Guidelines are explicit: “Codes titled ‘unspecified’ are for use when the information in the medical record is insufficient to assign a more specific code.” “Insufficient” means after full review — not before it.
❌ Excludes
Excludes 2 — Assign Diabetic Code Instead When DM Is the Etiology1
| Code Range | Description | Action |
|---|---|---|
| E08.311-E08.359 | Drug/chemical-induced DM with diabetic retinopathy | Use diabetic retinopathy code — NOT H35.3110 |
| E10.311-E10.359 | Type 1 DM with diabetic retinopathy | Use diabetic retinopathy code — NOT H35.3110 |
| E11.311-E11.359 | Type 2 DM with diabetic retinopathy | Use diabetic retinopathy code — NOT H35.3110 |
| E13.311-E13.359 | Other specified DM with diabetic retinopathy | Use diabetic retinopathy code — NOT H35.3110 |
📋 Clinical Overview
Why Stage Is Almost Always Determinable — And Therefore Why H35.3110 Should Be Rare
Unlike many conditions where “unspecified” reflects genuine clinical uncertainty about diagnosis type, AMD stage is almost always objectively determinable from routine ophthalmologic examination findings. Every dilated fundus exam and OCT performed for AMD monitoring generates objective data that directly maps to Beckman staging criteria. The staging information exists in the clinical record — the challenge is finding and reading it correctly.2
The following documentation sources, often overlooked by coders reviewing only the discharge summary or impression line, frequently contain the staging information needed to avoid H35.3110:4
| Documentation Source | What to Look For |
|---|---|
| OCT report | Drusen volume, drusen size measurements, presence of subretinal fluid, geographic atrophy boundaries |
| Fundus photography report | Drusen count, size description, pigmentary changes, GA delineation |
| Fluorescein angiography report | CNV presence/absence, GA boundaries, hyperfluorescence pattern |
| Ophthalmology consultation note | Detailed examination findings section — often includes drusen description even when impression is vague |
| Previous encounter notes | Stage documented at prior visit — apply if no documented change |
| Medication list | AREDS2 present → intermediate AMD highly likely → query |
| Referral letter | Referring provider may have explicitly staged the AMD |
| Nursing assessment | ”Patient reports monitoring with Amsler grid for intermediate AMD” |
The Most Common H35.3110 Coding Error — Lazy Documentation Review
The most frequently encountered inappropriate use of H35.3110 is the coder who reviews only the physician impression or discharge diagnosis — sees “AMD, right eye” without a stage label — and immediately assigns H35.3110 without reviewing the examination findings, OCT report, or fundus photography interpretation. In ophthalmology, the objective findings section almost always contains drusen size and pigmentary change documentation that enables stage assignment without the physician ever using the words “early,” “intermediate,” or “advanced.”
Read the full note before querying. Read the imaging reports before assigning unspecified.
When H35.3110 Is Legitimately Appropriate
Per ICD-10-CM Official Guidelines and ACDIS/AHIMA query guidance, H35.3110 is appropriate in these limited scenarios:
| Legitimate Scenario | CDI Action |
|---|---|
| Consultation note not yet transcribed at time of coding; impression from attending only says “AMD right eye” | Assign H35.3110 interim; flag for retrospective correction when consult populates |
| Telehealth screening read returns “AMD findings, right eye” without staging details | H35.3110 pending in-person follow-up evaluation |
| Legacy medical records with no objective findings documented and physician unavailable for query | H35.3110 is the only defensible option |
| CDI query submitted — no physician response received before bill drop | H35.3110 interim; retrospective correction if response arrives after submission |
| New patient referred with outside records that only document “AMD” — no prior imaging or exam findings available | H35.3110 until in-office evaluation establishes stage |
CDI Query Framework for AMD Staging
When submitting a CDI query to resolve H35.3110 to a stage-specific code, the query should:
Include:
- The clinical indicators that prompted the query (e.g., “OCT report documents drusen deposits; impression states ‘AMD, right eye’ without stage”)
- A multiple-choice or open-ended format per AHIMA 2022 query guidelines
- Compliant, non-leading language
Sample Query Language:
“The medical record documents AMD of the right eye. To ensure accurate code assignment, please specify the clinical stage of the nonexudative AMD affecting the right eye as of this encounter: — Early dry stage (medium drusen ≥63μm to <125μm, no pigmentary abnormalities) — Intermediate dry stage (large drusen ≥125μm and/or pigmentary abnormalities, no geographic atrophy) — Advanced atrophic, without subfoveal involvement (geographic atrophy not at foveal center) — Advanced atrophic, with subfoveal involvement (geographic atrophy involving foveal center) — Unable to determine — Other: _______________”
"Unable to Determine" Is a Valid Query Response
Per AHIMA 2022 Compliant Query Practice guidelines, every query must include an “unable to determine” or “clinically undetermined” option. [web:106] If the physician selects this, H35.3110 is confirmed as the appropriate code — the physician has affirmatively stated that the stage is clinically indeterminate, which is a valid clinical scenario in rare circumstances (e.g., poor dilation, media opacity, patient unable to cooperate with examination). Document the query and the “unable to determine” response in the coding record.
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2025 Implementation) |
| HCC Assignment | ❌ Not Mapped |
| HCC Category | N/A |
| RAF Coefficient | 0.000 |
H35.3110 carries no direct HCC weight — identical to all H35.311x codes in this respect.
The Real RAF Cost of H35.3110 — Missed Comorbidity Context
While H35.3110 itself carries no RAF, the stage-unspecified designation creates a downstream documentation accuracy problem. Specifically:
- Advanced stages (H35.3113/H35.3114) frequently co-occur with vision impairment (H54.xx) — a condition that may carry future HCC significance. When the stage isn’t documented, vision impairment may not be separately coded.
- Intermediate stage (H35.3112) implies AREDS2 is indicated — if stage is unspecified, AREDS2 compliance documentation may be absent, weakening the clinical picture.
- Medication reconciliation errors are more likely when AMD stage is unknown to the inpatient team — anti-VEGF regimens can be mistakenly discontinued if the wet-vs-dry distinction isn’t clear.
Resolving H35.3110 to a stage-specific code doesn’t just serve coding accuracy — it serves the patient’s care record.
🏥 MS-DRG Assignment
MDC 02 — Diseases and Disorders of the Eye (if principal — virtually never for AMD)
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 124 | Other Disorders of the Eye with MCC | ~0.95-1.15 |
| DRG 125 | Other Disorders of the Eye with CC | ~0.70-0.90 |
| DRG 126 | Other Disorders of the Eye without CC/MCC | ~0.50-0.70 |
*Approximate. Verify against IPPS FY2025 Final Rule tables.3
H35.3110 Does Not Independently Affect DRG Tier
The stage-unspecified designation in H35.3110 carries no additional DRG weight over stage-specific codes in the same family — all H35.311x codes group to the same MDC 02 DRG family. The DRG tier depends entirely on CC/MCC burden from other diagnoses. However, if an advanced stage (H35.3113/H35.3114) with associated vision impairment is incorrectly coded as H35.3110, the missing vision impairment code (H54.xx) may represent a lost CC — a DRG tier consequence that would have moved the encounter from DRG 126 to DRG 125. Staging accuracy matters for DRG completeness even when the AMD code itself is not the driver.
🔗 Related ICD-10-CM Codes
The Full H35.3110 Decision Replacement Table
| Instead of H35.3110, Use This When… | Code | Stage |
|---|---|---|
| Medium drusen (≥63-<125μm), no pigment changes documented | H35.3111 | Early dry |
| Large drusen (≥125μm) or pigmentary changes documented | H35.3112 | Intermediate dry |
| Geographic atrophy documented, not subfoveal | H35.3113 | Advanced, no subfoveal |
| Geographic atrophy documented, subfoveal | H35.3114 | Advanced, subfoveal |
| Only laterality is unspecified too | H35.3190 | Stage AND laterality unspecified ⚠️ |
Laterality Variants — Same Stage-Unspecified Family
| Code | Description |
|---|---|
| H35.3110 | Right eye, stage unspecified ← This Code |
| H35.3120 | Left eye, stage unspecified |
| H35.3130 | Bilateral, stage unspecified |
| H35.3190 | Unspecified eye, stage unspecified ⚠️⚠️ — double unspecified; two separate CDI queries needed |
H35.3190 — Double Unspecified — Highest Audit Risk in the AMD Family
H35.3190 (nonexudative AMD, unspecified eye, stage unspecified) carries both an unspecified laterality and an unspecified stage. This is the worst-case documentation failure in the H35.31x family and requires two separate CDI queries (one for laterality, one for stage). Payers specifically flag double-unspecified codes in ophthalmology during prepayment review. If you ever find yourself about to assign H35.3190, treat it as a mandatory hold until both laterality and stage can be clarified.
The AMD Family — Full Navigation Reference
| Code | Stage | Laterality | Billable? | Priority |
|---|---|---|---|---|
| H35.31 | — | — | ❌ | Header — never submit |
| H35.311 | — | Right | ❌ | Header — never submit |
| H35.3110 | Unspecified ⚠️ | Right | ✅ | Last resort |
| H35.3111 | Early | Right | ✅ | Preferred |
| H35.3112 | Intermediate | Right | ✅ | Preferred |
| H35.3113 | Advanced, no subfoveal | Right | ✅ | Preferred |
| H35.3114 | Advanced, subfoveal | Right | ✅ | Preferred |
🛠️ Commonly Associated CPT Codes (Ophthalmology)
CPT Codes Are the Same — The Diagnosis Documentation Is the Gap
| CPT Code | Description | H35.3110 Application |
|---|---|---|
| 92004 | Ophthalmological exam, comprehensive, new patient | Initial evaluation when AMD is suspected but full staging documentation incomplete |
| 92014 | Ophthalmological exam, comprehensive, established patient | Follow-up — monitoring frequency cannot be formally justified without stage; document why stage is indeterminate |
| 92250 | Fundus photography with interpretation | Provides objective drusen characterization — reviewing this report frequently resolves the unspecified stage |
| 92134 | OCT posterior segment | OCT report contains drusen volume and size data — reviewing this report frequently eliminates need for H35.3110; supported by CMS LCD for H35.3110 |
| 92235 | Fluorescein angiography | CNV exclusion; CNV absence confirms dry AMD; report may contain stage-useful pigmentary information |
The OCT Report and Fundus Photography Report Are Your First Line of Defense Against H35.3110
Before submitting a CDI query for AMD staging, read the OCT posterior segment report (92134) and the fundus photography report (92250) in full. These reports routinely contain drusen size measurements, drusen volume quantification, RPE integrity assessments, and geographic atrophy delineation — all of which directly support stage assignment without requiring physician clarification. In most cases, H35.3110 is preventable simply by reading the imaging reports before coding the impression.
💊 Coding Scenarios and Examples
Scenario 1 — “AMD Right Eye” in Impression Only — Imaging Reports Not Yet Reviewed (Outpatient)
Clinical Vignette: A coder reviews an outpatient ophthalmology claim. The physician impression reads: “AMD, right eye — stable, follow up 6 months.” No stage is mentioned. The coder has not yet reviewed the OCT or fundus photography reports in the chart.
Incorrect Immediate Action:
- ❌ Assigning H35.3110 without reviewing imaging reports
Correct Action:
- Pull the OCT posterior segment report from the same date of service — it documents “multiple large drusen (estimated 125-200μm) at the posterior pole with focal RPE hyperpigmentation, right eye”
- These findings = large drusen ≥125μm + pigmentary changes = intermediate AMD
- Assign H35.3112 — no CDI query required because the clinical indicators are already documented in the imaging report
ICD-10-CM (Corrected):
- H35.3112 — Nonexudative AMD, right eye, intermediate dry stage
H35.3110 Avoided — By Reading the Full Record
This is the most common avoidable use of the stage-unspecified code. The imaging report contained all the staging information needed. The 30 seconds it takes to pull the OCT report prevents a documentation deficiency code, a potential payer medical records request, and inaccurate AREDS2 counseling documentation.
Scenario 2 — Consult Note Pending at Time of Coding (Inpatient)
Clinical Vignette: A patient is admitted for a hip fracture. H&P by the hospitalist documents: “PMH: AMD right eye — followed by retina.” Ophthalmology is consulted on day 2 for visual assessment but their formal note has not been transcribed into the EHR by the time the coder reviews the chart at discharge.
ICD-10-CM (Interim):
- H35.3110 — Nonexudative AMD, right eye, stage unspecified (interim — ophthalmology consult note pending)
Coding Action:
- Assign H35.3110 as interim additional diagnosis
- Flag the note: “H35.3110 — AMD right eye — ophthalmology consult note not yet transcribed; retrospective correction needed when note populates”
- When consult note populates: review for staging findings → correct to appropriate H35.3111-H35.3114 code before bill drop if within the bill-hold window
Bill-Hold Window Is Your Friend
Most inpatient facilities have a 3-7 day bill-hold period between discharge and claim submission. Use this window to chase pending consult notes. Correcting H35.3110 to a stage-specific code before the claim drops eliminates the unspecified code from the submitted claim entirely — no amendment needed, no payer audit risk.
Scenario 3 — New Patient with Outside Records Only (Outpatient)
Clinical Vignette: A 79-year-old female transfers care to a new retina specialist. She brings a summary from her previous ophthalmologist that reads: “AMD, right eye — on AREDS2.” No staging documentation, no prior imaging reports. The new physician’s first in-office dilated exam, OCT, and fundus photography have not yet been performed today — this is a brief established-care transfer visit only.
ICD-10-CM:
- H35.3110 — Nonexudative AMD, right eye, stage unspecified (appropriate interim — no objective findings available from prior records; first in-office imaging not yet performed)
Coding Action:
- H35.3110 is appropriate here — no imaging data is available to stage the AMD
- Document in coding notes: “AREDS2 on medication list — intermediate AMD probable — stage to be confirmed at first complete exam visit”
- At the next visit with full OCT and fundus photography: correct to appropriate stage-specific code
- Do not infer H35.3112 solely from AREDS2 use without physician staging confirmation — even though intermediate AMD is probable, the code still requires documentation support
AREDS2 Alone Is a Clue — Not Proof
The presence of AREDS2 on the medication list strongly suggests intermediate AMD (H35.3112) — but “strongly suggests” is not the documentation standard required to assign a stage-specific code. Per coding guidelines, the stage must be documented or inferable from documented clinical findings. [web:104] Medication use alone, without corresponding documentation of the clinical findings that indicate the stage, supports a CDI query — not a direct code assignment. After the query is answered or after in-office imaging is performed and reported, the stage-specific code can be assigned.
Scenario 4 — CDI Query Submitted — Response Received (Inpatient Coding Correction)
Clinical Vignette: Following Scenario 2 (hip fracture admission), the coder submits a CDI query to the consulting ophthalmologist asking for AMD staging. Three days later (still within bill-hold window), the ophthalmologist responds: “Intermediate dry AMD, right eye — large drusen present, no geographic atrophy, no CNV.”
ICD-10-CM (Corrected Before Bill Drop):
- H35.3112 — Nonexudative AMD, right eye, intermediate dry stage (corrected from H35.3110 per CDI query response — intermediate dry confirmed)
Query Workflow Succeeded — H35.3110 Never Appears on the Final Claim
Scenario 5 — CDI Query Returns “Unable to Determine” (Outpatient Legacy Record)
Clinical Vignette: A coder is coding a new Medicare Advantage patient’s annual wellness visit from a legacy EHR system. The patient’s problem list reads “AMD” without laterality or stage. The annual wellness visit note says only “AMD — continue follow-up with ophthalmologist.” No ophthalmology records are attached. The ophthalmologist is at an outside practice and cannot be reached for a query before claim submission.
ICD-10-CM:
- H35.3110 — Nonexudative AMD, right eye, stage unspecified (appropriate — staging information unavailable; outside provider cannot be queried before bill drop)
What If Laterality Is Also Absent?
In this scenario, if the record said only “AMD” with no laterality (right, left, bilateral) AND no stage, the appropriate code would be H35.3190 (nonexudative AMD, unspecified eye, stage unspecified) — the double-unspecified code. This is appropriate when documentation is genuinely insufficient for both laterality and staging. Flag for follow-up at the patient’s next visit when ophthalmology records can be obtained and both laterality and stage can be confirmed and corrected.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Never use H35.3110 as a default — always exhaust imaging reports, consult notes, and prior visit documentation before accepting stage unspecified |
| ❌ | Do not assign H35.3110 because the impression doesn’t use the word “early” or “intermediate” — read the examination findings and imaging reports; stage is almost always determinable from objective documentation |
| ❌ | Do not submit H35.311 (6-character) thinking it equals H35.3110 — they are different; H35.311 is a non-billable header; H35.3110 with the “0” is the billable stage-unspecified code |
| ❌ | Do not infer stage from AREDS2 use alone without documentation of the clinical findings — use AREDS2 to prompt a CDI query, not to assign H35.3112 without documentation support |
| ❌ | Do not use H35.3110 for a patient who has wet AMD — wet AMD is H35.3211 and family; H35.3110 is exclusively for dry (nonexudative) AMD with unspecified stage |
| ❌ | Do not accept “unable to determine” as a physician response without confirming it is clinically genuine — if the physician can determine the stage from their own examination notes, “unable to determine” may reflect a query engagement issue, not a true clinical uncertainty |
| ✅ | Read OCT reports and fundus photography reports FIRST — these almost always contain the staging information; H35.3110 is frequently avoidable without a query at all |
| ✅ | Use H35.3110 as an interim code — assign it, flag it, and plan to correct it before bill drop or after CDI query response |
| ✅ | Submit the CDI query with multiple-choice staging options per AHIMA 2022 guidelines — include “unable to determine” as a valid option; non-leading format is required [web:106] |
| ✅ | Retroactively correct H35.3110 when pending documentation populates during the bill-hold period — the corrected stage-specific code should appear on the final claim, not the unspecified code |
| ✅ | Document your review trail — in your coding notes, record what sources you checked, why staging could not be determined, and what CDI action was taken; this creates an auditable record supporting the use of H35.3110 |
| ✅ | Track H35.3110 frequency in quality reviews — a high rate of stage-unspecified AMD coding in your facility may signal an ophthalmology documentation improvement opportunity; CDI education with the retina practice can drive specificity upstream |
📚 Sources
1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2025; Tabular List — H35.31 Nonexudative AMD, 7th character staging instructions; H35 Excludes 2 notation; General Coding Guidelines Section I.B.5 — Unspecified codes: “Codes titled ‘unspecified’ are for use when the information in the medical record is insufficient to assign a more specific code.” [web:103]
2. Ferris FL, Wilkinson CP, Bird A, et al. “Clinical Classification of Age-related Macular Degeneration.” Ophthalmology. 2013;120(4):844-851. Beckman Clinical Classification — staging criteria providing objective clinical determinability for all AMD stages.
3. CMS. IPPS Final Rule FY2025 — MS-DRG Definitions Manual v42. MDC 02 — Diseases and Disorders of the Eye, DRGs 124-126.
4. ACDIS/AHIMA. “When to Query Unspecified Diagnoses.” December 2015. “Unspecified codes in ICD-10 should be used when it most accurately reflects what is known about the patient’s condition at the time of that particular encounter.” Coding to certainty, not assumption. [web:104]
5. ACDIS. “Q&A: Querying for Unspecified Diagnoses.” February 2019. CDI team query prioritization — query when coding requires clarification, when physician should know the answer, and when specificity impacts reimbursement or quality metrics. [web:102]
6. AHIMA. Guidelines for Achieving a Compliant Query Practice (2022 Update). AHIMA/ACDIS joint practice brief. Multiple-choice query format, “unable to determine” option requirement, non-leading language standards. [web:106]
7. icdlist.com. “ICD-10-CM Diagnosis Code H35.3110 — Nonexudative age-related macular degeneration, right eye, stage unspecified.” Confirmed billable FY2025. [web:101]
8. Outsource Strategies International. “Coding Macular Degeneration — A Common Age-Related Eye Condition.” September 2025. Full H35.31xx code hierarchy reference table. [web:77]