Optometry Coding & Billing Alert

ICD-10:

Know the New Dx Options for Diabetes With Ophthalmic Manifestations

In some cases, one code will do where you once needed two.

The countdown is on: You now have less than a year before the ICD-10 diagnosis codes officially replace the ICD-9 codes, on Oct. 1, 2015. Some of the biggest changes optometry coders will need to get their heads around are the codes for diabetes with ophthalmic manifestations.

Old way: Under ICD-9, often you would need two codes for a condition such as proliferative diabetic retinopathy — one code for the underlying diabetic condition (250.52, Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled) and one for the specific ophthalmic manifestation (362.02, Proliferative diabetic retinopathy).

New way: ICD-10 introduces a number of new codes that describe both the underlying condition and the ophthalmic manifestation, doing away with the need to report two codes: The E11.3-- (Type 2 diabetes mellitus with ophthalmic complications) range of codes specifies type II diabetes mellitus, with specific codes detailing the type and severity of ophthalmic complication:

  • E11.311 — Type 2 diabetes mellitus with unspecified diabetic retinopathy; with macular edema
  • E11.319 — ...without macular edema
  • E11.321 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy; with macular edema
  • E11.329 — ...without macular edema
  • E11.331 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy; with macular edema
  • E11.339 — ...without macular edema
  • E11.341 — Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy; with macular edema
  • E11.349 — ...without macular edema
  • E11.351 — Type 2 diabetes mellitus with proliferative diabetic retinopathy; with macular edema
  • E11.359 — ...without macular edema
  • E11.36 — Type 2 diabetes mellitus with diabetic cataract
  • E11.39 — Type 2 diabetes mellitus with other diabetic ophthalmic complication.

Learn more: For more information on the ICD-10 conversion, as well as specific ICD-9 to ICD-10 code bridges, visit https://www.aapc.com/codes/.