ICD-10: H35.14

Retinopathy of prematurity (ROP) is a significant ocular condition primarily affecting premature infants. The ICD-10 code H35.14 specifically refers to "Retinopathy of prematurity, stage 3," which is a critical stage in the progression of this disease. Below is a detailed clinical description and relevant information regarding this condition.

Overview of Retinopathy of Prematurity

Retinopathy of prematurity is characterized by abnormal blood vessel development in the retina of premature infants. It typically occurs in infants born before 31 weeks of gestation or those with a birth weight of less than 1500 grams. The condition can lead to severe visual impairment or blindness if not monitored and treated appropriately.

Staging of Retinopathy of Prematurity

ROP is classified into five stages, with stage 3 being a pivotal point where the disease can progress significantly:

• Stage 1: Mildly abnormal blood vessel growth.
• Stage 2: Moderately abnormal blood vessel growth.
• Stage 3: Severely abnormal blood vessel growth, which may be associated with the presence of neovascularization (the formation of new blood vessels) and can lead to retinal detachment if untreated.
• Stage 4: Partial retinal detachment.
• Stage 5: Total retinal detachment.

Clinical Features of Stage 3 ROP

In stage 3 ROP, the following clinical features are typically observed:

• Neovascularization: This is a hallmark of stage 3, where new, fragile blood vessels grow in the retina and can lead to complications such as bleeding.
• Retinal Changes: The retina may exhibit signs of scarring or traction due to the abnormal blood vessels.
• Visual Impairment: Infants with stage 3 ROP are at a higher risk of developing significant visual impairment or blindness, necessitating close monitoring and potential intervention.

Diagnosis and Management

Diagnosis

Diagnosis of ROP, including stage 3, is performed through a comprehensive eye examination, typically conducted by a pediatric ophthalmologist. The examination involves:

• Indirect Ophthalmoscopy: This allows for a detailed view of the retina and the assessment of blood vessel development.
• Fundus Photography: This may be used to document the condition and monitor progression.

Management

Management strategies for stage 3 ROP may include:

• Laser Therapy: This is often the first-line treatment to ablate the peripheral retina and reduce the risk of progression to more severe stages.
• Cryotherapy: In some cases, cryotherapy may be used to treat the abnormal blood vessels.
• Monitoring: Regular follow-up examinations are crucial to assess the progression of the disease and the effectiveness of treatment.

Prognosis

The prognosis for infants diagnosed with stage 3 ROP varies. Early detection and treatment can significantly improve outcomes, but some infants may still experience long-term visual impairment. Continuous follow-up is essential to manage any complications that may arise.

Conclusion

ICD-10 code H35.14 identifies retinopathy of prematurity at stage 3, a critical stage that requires prompt diagnosis and intervention to prevent severe visual impairment. Understanding the clinical features, diagnostic methods, and management options is vital for healthcare providers involved in the care of premature infants. Early intervention can lead to better visual outcomes and improved quality of life for affected individuals.

Retinopathy of prematurity (ROP) is a significant condition affecting premature infants, particularly those with low birth weight. The ICD-10 code H35.14 specifically refers to stage 3 of this condition, which is characterized by certain clinical presentations, signs, symptoms, and patient characteristics.

Clinical Presentation of Stage 3 Retinopathy of Prematurity

Stage 3 ROP is defined by the presence of abnormal blood vessel growth in the retina, which can lead to serious complications, including retinal detachment. The clinical presentation typically includes:

• Vascular Abnormalities: In stage 3, there is evidence of neovascularization, where new, abnormal blood vessels grow in the retina. This can be observed during a dilated eye examination.
• Retinal Hemorrhages: These may occur due to the fragile nature of the newly formed vessels, leading to bleeding within the retina.
• Exudates: The presence of exudates, which are deposits of protein and lipids, can be noted in the retina.

Signs and Symptoms

The signs and symptoms of stage 3 ROP can vary, but they often include:

• Visual Impairment: Infants may exhibit signs of visual impairment, although this can be difficult to assess in very young patients.
• Strabismus: Misalignment of the eyes may be observed, which can indicate underlying visual issues.
• Abnormal Eye Movements: Infants may show unusual eye movements or difficulty tracking objects.
• Retinal Changes: During examination, ophthalmologists may note the presence of plus disease, characterized by dilated and tortuous retinal vessels, indicating worsening disease.

Patient Characteristics

Certain characteristics are commonly associated with infants diagnosed with stage 3 ROP:

• Prematurity: Most affected infants are born before 32 weeks of gestation, with a higher incidence in those born before 28 weeks.
• Low Birth Weight: Infants with a birth weight of less than 1500 grams are at increased risk for developing ROP.
• Oxygen Therapy: Many infants who develop ROP have received supplemental oxygen, which is a known risk factor for the condition.
• Other Medical Conditions: Conditions such as intraventricular hemorrhage or sepsis may also be present, complicating the clinical picture.

Conclusion

Stage 3 retinopathy of prematurity is a critical condition that requires careful monitoring and management. Early detection through regular eye examinations in at-risk infants is essential to prevent progression to more severe stages, including retinal detachment. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition can aid healthcare providers in delivering timely and effective care. Regular follow-up and intervention strategies are crucial for improving visual outcomes in affected infants.

Retinopathy of prematurity (ROP) is a significant condition affecting premature infants, and the ICD-10 code H35.14 specifically refers to stage 3 of this disease. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with ICD-10 code H35.14.

Alternative Names for Retinopathy of Prematurity, Stage 3

1. Severe Retinopathy of Prematurity: This term is often used to describe the advanced nature of stage 3 ROP, indicating a critical level of retinal damage.

2. Stage 3 ROP: A simplified reference that directly indicates the specific stage of the disease without additional descriptors.

3. Retinopathy of Prematurity, Type 3: This nomenclature is sometimes used interchangeably with stage 3, particularly in clinical discussions.

4. Proliferative Retinopathy of Prematurity: While this term is more commonly associated with later stages, it can sometimes be used to describe the severe vascular changes occurring in stage 3.

Related Terms

1. Retinal Detachment: In severe cases of ROP, particularly in stage 3, there is a risk of retinal detachment, which is a critical complication.

2. Vascular Abnormalities: This term refers to the abnormal blood vessel growth that characterizes ROP, especially in its more severe stages.

3. Ophthalmic Examination: This is a related term that encompasses the procedures used to diagnose and monitor ROP, including stage 3.

4. Neovascularization: This term describes the formation of new blood vessels, which is a hallmark of ROP and is particularly relevant in stage 3.

5. Premature Infant Eye Disease: A broader term that encompasses various eye conditions, including ROP, affecting premature infants.

6. Retinopathy of Prematurity Classification: This refers to the system used to categorize the severity of ROP, which includes stages 1 through 5.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H35.14 is essential for healthcare professionals involved in the diagnosis and treatment of retinopathy of prematurity. These terms facilitate better communication among medical staff and enhance the clarity of medical records. As ROP can lead to significant visual impairment if not managed properly, awareness of its terminology is crucial in clinical practice.

Retinopathy of prematurity (ROP) is a significant concern in neonatal care, particularly for premature infants. The diagnosis of ROP, specifically stage 3, is guided by specific clinical criteria and diagnostic codes, including the ICD-10 code H35.14. Below, we will explore the criteria used for diagnosing stage 3 ROP, the implications of this diagnosis, and the relevant coding guidelines.

Understanding Retinopathy of Prematurity

Retinopathy of prematurity is a condition that affects the retina of premature infants, where abnormal blood vessels grow in the retina, potentially leading to vision impairment or blindness. The condition is classified into five stages, with stage 3 indicating the presence of more severe changes in the retina.

Criteria for Diagnosis of Stage 3 ROP

The diagnosis of stage 3 ROP is based on the following criteria:

1. Clinical Examination: A comprehensive eye examination is essential. This typically involves indirect ophthalmoscopy to assess the retina's condition. The examination should be performed by a qualified ophthalmologist or pediatric ophthalmologist.

2. Presence of Neovascularization: Stage 3 ROP is characterized by the presence of neovascularization, which refers to the growth of new blood vessels in the retina. This is a critical factor in diagnosing stage 3.

3. Extent of Disease: The extent of the disease is evaluated, including the area of the retina affected by the abnormal blood vessels. The classification system used includes zones (I to III) and the presence of plus disease, which indicates a more severe form of ROP.

4. Plus Disease: The presence of plus disease, which is defined by the dilation and tortuosity of the retinal blood vessels, can influence the diagnosis and management of ROP. In stage 3, plus disease may be present, indicating a more severe condition.

5. Gestational Age and Birth Weight: The infant's gestational age and birth weight are also considered, as ROP is more common in infants born before 28 weeks of gestation or those with a low birth weight.

Diagnostic Codes and Guidelines

The ICD-10 code H35.14 specifically refers to "Retinopathy of prematurity, stage 3." This code is part of a broader classification system that helps healthcare providers document and bill for the diagnosis accurately.

• ICD-10-CM Guidelines: The guidelines for coding ROP emphasize the importance of documenting the stage of the disease, the presence of plus disease, and any associated complications. Accurate coding is crucial for treatment planning and insurance reimbursement.

• Follow-Up and Monitoring: Infants diagnosed with stage 3 ROP require close monitoring and may need treatment, such as laser therapy or anti-VEGF injections, to prevent progression to more severe stages, including stage 4 or 5, which can lead to retinal detachment and significant vision loss.

Conclusion

Diagnosing stage 3 retinopathy of prematurity involves a thorough clinical examination, assessment of neovascularization, and consideration of the infant's gestational age and birth weight. The use of the ICD-10 code H35.14 allows for standardized documentation and billing, ensuring that affected infants receive appropriate care and follow-up. Early detection and intervention are critical in managing ROP and preserving vision in premature infants.

Retinopathy of prematurity (ROP) is a significant concern in neonatal care, particularly for premature infants. The condition is characterized by abnormal blood vessel growth in the retina, which can lead to vision impairment or blindness if not treated appropriately. Stage 3 ROP indicates the presence of abnormal blood vessels and is classified as "plus disease" when there is significant vascular dilation and tortuosity. Here, we will explore the standard treatment approaches for ROP, specifically for stage 3, as indicated by the ICD-10 code H35.14.

Treatment Approaches for Stage 3 Retinopathy of Prematurity

1. Laser Photocoagulation Therapy

Laser photocoagulation is one of the most common and effective treatments for stage 3 ROP. This procedure involves using a laser to destroy the peripheral retina, which helps to reduce the stimulus for abnormal blood vessel growth. By targeting the areas of the retina that are not receiving adequate blood supply, the treatment aims to prevent progression to more severe stages of ROP, including retinal detachment. Studies have shown that early intervention with laser therapy can significantly improve visual outcomes in affected infants[1].

2. Cryotherapy

Cryotherapy, or cryoablation, is another treatment option that involves freezing the peripheral retina to halt the progression of ROP. While less commonly used than laser therapy today, it can still be effective in certain cases. The procedure aims to induce scarring in the retina, which can help stabilize the condition. However, it is generally considered less favorable compared to laser treatment due to potential complications and less favorable long-term visual outcomes[2].

3. Anti-VEGF Injections

Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents, such as aflibercept (Eylea®), have emerged as a promising treatment for ROP. These medications work by inhibiting the action of VEGF, a protein that promotes abnormal blood vessel growth. Anti-VEGF therapy can be particularly beneficial in cases of aggressive ROP, and studies have indicated that it can lead to favorable visual outcomes while potentially reducing the need for laser treatment[3][4].

4. Monitoring and Follow-Up

Close monitoring is crucial for infants diagnosed with stage 3 ROP. Regular eye examinations are necessary to assess the progression of the disease and the effectiveness of the treatment. Follow-up care may include additional laser treatments or anti-VEGF injections if the condition worsens. The timing of interventions is critical, as early treatment is associated with better visual outcomes[5].

5. Multidisciplinary Care

Management of ROP often involves a multidisciplinary team, including neonatologists, ophthalmologists, and pediatricians. This collaborative approach ensures comprehensive care for the infant, addressing not only the ocular aspects of ROP but also the overall health and development of the premature infant. Supportive care in the neonatal intensive care unit (NICU) is also essential, as factors such as oxygen therapy and nutrition can influence the progression of ROP[6].

Conclusion

Stage 3 retinopathy of prematurity requires prompt and effective treatment to prevent severe visual impairment. Laser photocoagulation remains the standard treatment, with cryotherapy and anti-VEGF injections serving as additional options depending on the specific case. Continuous monitoring and a multidisciplinary approach are vital to ensure the best possible outcomes for affected infants. As research continues to evolve, new treatment modalities may further enhance the management of ROP, improving the prognosis for premature infants at risk.

References

1. Incidence, Long-Term Visual Outcomes, and Mortality in ROP.
2. Ophthalmology: Extended Ophthalmoscopy and Fundus.
3. Vascular Endothelial Growth Factor Inhibitors for Ocular Conditions.
4. Eylea® (aflibercept) Clinical Applications.
5. Clinical Policy: Electroretinography.
6. Health Technology Briefing October 2023.