5 Key Takeaways

• 1

  ICD-10-CM codes for wet AMD are based on laterality and require specific codes for right, left, bilateral, and unspecified eyes.

• 2

  A seventh digit indicates the stage of wet AMD, ranging from unspecified to active choroidal neovascularization or inactive scar.

• 3

  Documentation must include a confirmed diagnosis, disease stage, response to treatment, and necessary diagnostic imaging.

• 4

  Common claim denials arise from incorrect diagnosis codes, lack of prior authorization, and incomplete documentation of medical necessity.

• 5

  Prior authorization is often required by payors, and it is crucial to ensure that the request aligns with the diagnosis codes in documentation.