Ophthalmology and Optometry Coding Alert

Question: My physician often uses "macula edema" as his only diagnosis documentation. How can I tell which diagnosis code this correspond to 362.83 or 362.53?

Ohio Subscriber

Answer: The problem you have locating the correct ICD-9 code comes from your physician's inadequate description of the observed diagnosis. To determine the correct macular edema diagnosis code, you need to know whether the patient is diabetic and whether the macula edema is cystoid.

You are on the right track turning to 362.83 (Retinal edema) and 362.53 (Cystoid macular degeneration), but you need more information from your physician before you can choose which of these code descriptions best fits the patient's condition.

If the patient is not diabetic and does not have cystoid macular edema, choose code 362.83. If the patient is not diabetic and does have cystoid macular edema, you should use 362.53.

If the patient is diabetic and has diabetic retinal edema, use the retina diagnosis code 362.83 followed by the correct code for "diabetes with ophthalmic manifestations" 250.50 or 250.51. If the physician finds that the diabetic patient's macular edema is not diabetes-related, or if the physician is not sure if the diabetes is responsible for the macular edema, you should use 362.83 only. If the patient with diabetes has cystoid macular edema, you should use 362.53 only, because the condition is not diabetes-related.

Answers to You Be the Coder and Reader Questions contributed by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.