Ophthalmology and Optometry Coding Alert

Answer: Diagnosis coding for patients who have diabetes with ophthalmic manifestations gets complicated quickly.

Approach this as you would any other: Look up the condition in the alphabetical index, Volume 2 of your ICD-9-CM manual. Under the condition, retinopathy, you will find a "diabetic" subsection and a descriptor of "proliferative." Two codes are listed: 250.5 and [362.02]. But don't stop here. A fifth-digit indicator follows the first code, 250.5, which means it is imperative that you use Volume 1 to append one more digit to the code. The list of fifth digits for the 250 category of codes is at the beginning of the subsection. Of the four possible fifth digits 0, 1, 2 and 3 only "1" specifies that the patient diabetes are type I, insulin-dependent and not stated as uncontrolled. Therefore, you should list 250.51 as the primary diagnosis code.

362.02, proliferative diabetic retinopathy, should be listed as your secondary diagnosis. Codes in brackets in Volume 2 of the ICD-9-CM manual can never be listed as the primary diagnosis. In this case, 362.02 identifies the manifestation of the diabetes.