Q12.0 — Congenital cataract
Q12.0 is a billable, specific ICD-10-CM code for congenital cataract. It is valid for submission on a claim.
Other codes that can never be billed with Q12.0
These codes carry an Excludes1 note pointing at Q12.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q12.0 alone.
- H26Other cataract
Risk adjustment
Q12.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
Q12.0 is named in 8 Medicare coverage policies — 8 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
- A56544Billing and Coding: Cataract Extraction
- A56549Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
- A56613Billing and Coding: Cataract Surgery
How Q12.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Q12.0.
- Blue›dot cataract
- Cataract›blue
- Cataract›central
- Cataract›cerulean
- Cataract›congenital
- Cataract›coraliform
- Cataract›coronary
- Cataract›crystalline
- Cataract›zonular(perinuclear)
- Cataracta›centralis pulverulenta
- Cataracta›cerulea
- Cataracta›congenita
Related codes at this level
Codes that share Q12. If Q12.0 is not quite right, the correct code is usually one of these.
Questions about Q12.0
- Is Q12.0 a billable ICD-10-CM code?
- Yes. Q12.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q12.0 sit in the tabular list?
- Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of eye, ear, face and neck (Q10-Q18).