Ophthalmology and Optometry Coding Alert

Distinguish between mild, moderate or severe retinopathy - and use a separate code for DME - beginning Oct. 1 Ophthalmology coders have long wished for a more specific way to code the severity of nonproliferative diabetic retinopathy (DR). On Oct. 1 of this year, you will get your wish with five new ICD-9 codes in the 362.0 series.
 
The new codes, which were published in a proposed rule in the May 4, 2005, Federal Register, are:
   362.03 - Nonproliferative diabetic retinopathy NOS
   362.04 - Mild nonproliferative diabetic retinopathy
   362.05 - Moderate nonproliferative diabetic retinopathy
   362.06 - Severe nonproliferative diabetic retinopathy
   362.07 - Diabetic macular edema. 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. "Modification of current codes will better represent the clinical presentation of DR and DME."
 
Key: These codes take effect on Oct. 1, 2005, says Twila Swartz, CPC, coder for Paul Munden, MD, PA, an Amarillo, Texas, ophthalmologist. Remember that you no longer have a grace period to begin using new ICD-9 codes, Swartz says, so be ready to integrate these codes into your practice on Oct. 1. 
 
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. The new codes appear in the back, in tables 6A-6E.