Optometry Coding & Billing Alert

These codes join 362.01 (Background diabetic retinopathy) and 362.02 (Proliferative diabetic retinopathy) in the 362.0 series. ICD-9 2005 now specifies that 362.01 includes diabetic macular edema (DME), which will presumably change when 362.07 goes into effect.

The new codes are a result of ophthalmic industry input during the October 2004 ICD-9 CM Coordination and Maintenance Committee Meeting. Matthew J. Sheetz, MD, PhD, representing Eli Lilly, argued for the new codes and for other ICD-9 revisions, saying that "background diabetic retinopathy," represented by ICD-9 code 362.01, is an "older term that does not represent current AAO [American Academy of Ophthalmology] language."

And, 362.01 "does not allow for clear understanding of disease progression," Sheetz said in his presentation to the committee. "Modification of current codes will better represent the clinical presentation of DR and DME."

Use Dilated Findings to Determine Code

So when should you code mild, as opposed to moderate or severe, diabetic retinopathy? Sheetz noted the AAO's "International Clinical Diabetes Disease Severity Scale," which distinguishes the different stages of the disease, based on your dilated ophthalmoscopy findings in chart at right.

Chart Source: "Preferred Practice Pattern: Diabetic Retinopathy," American Academy of Ophthalmology, 2003.

Key: These codes take effect on Oct. 1, 2005, says Sue Wilson, billing specialist for Miller Vision in Ironwood, Mich. Remember that you no longer have a grace period to begin using new ICD-9 codes, so be ready to integrate these codes into your practice on Oct. 1, she says.

Note: To see the complete list of new codes, you can download the proposed rule from http://www.cms.hhs.gov/providerupdate/regs/cms1500p.pdf.