2024 ICD-10-CM Diagnosis Code Z96.1

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Anterior capsule covering intraocular lens 360 degrees
• Anterior chamber intraocular lens present
• Artificial lens in position
• Artificial lens present
• Artificial lens present in left eye
• Artificial lens present in right eye
• Bilateral pseudophakia
• H/O: artificial eye lens
• History of cataract extraction
• History of exchange of intraocular lens
• History of implantation of anterior chamber intraocular lens
• History of implantation of posterior chamber intraocular lens
• History of implantation of posterior chamber intraocular lens
• History of penetrating keratoplasty
• History of penetrating keratoplasty with implantation of posterior chamber intraocular lens
• History of phacoemulsification of cataract with implantation of intraocular lens
• History of secondary lens implant
• Lens capsule clarity in pseudophakia - finding
• Lens capsule clarity in pseudophakia - finding
• Lens capsule clarity in pseudophakia - finding
• Lens capsule clear in pseudophakia
• Lens capsule folds in pseudophakia
• Lens capsule in pseudophakia finding
• Lens capsule in pseudophakia finding
• Lens capsule in pseudophakia finding
• Lens capsule in pseudophakia finding
• Lens capsule in pseudophakia finding
• Lens capsule opacity in pseudophakia
• Lens capsule open in pseudophakia
• Piggyback intraocular lens
• Position of artificial lens - finding
• Position of artificial lens - finding
• Pupillary capture of intraocular lens
• Tilted intraocular lens

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

• Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Z96.1 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
124	OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT	02	1.3219
125	OTHER DISORDERS OF THE EYE WITHOUT MCC	02	0.7975

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert Z96.1 to ICD-9-CM

• ICD-9-CM Code: V43.1 - Lens replacement NEC

Patient Education

Cataract

A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other. Common symptoms are:

• Blurry vision
• Colors that seem faded
• Glare - headlights, lamps or sunlight may seem too bright. You may also see a halo around lights.
• Not being able to see well at night
• Double vision
• Frequent prescription changes in your eye wear

Cataracts usually develop slowly. New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses can help at first. Surgery is also an option. It involves removing the cloudy lens and replacing it with an artificial lens. Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts.

NIH: National Eye Institute

[Learn More in MedlinePlus]

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.