Optometry Coding & Billing Alert

Published on Tue Mar 15, 2016 PDF

Question: For a diagnosis of diabetic retinopathy with ICD-10 codes, do we still have to use another diagnosis code for the ophthalmic manifestation, like we did with ICD-9?

Florida Subscriber

Answer: Not unless the ophthalmic manifestation is not already covered in the “Diabetes with Ophthalmic Manifestations” ICD-10 codes. The good news is that ICD-10 introduced a number of new codes that described both the underlying condition (diabetes) and the ophthalmic manifestation (e.g., macular edema). 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.

The E10.3 (Type 1 diabetes mellitus with ophthalmic complications) series is similarly broken down with specific ophthalmic manifestations.

However: Not all ophthalmic manifestations are covered in the E10.3 and E11.3 series. For example, E10.39 (Type 1 diabetes mellitus with other diabetic ophthalmic complication) contains an instruction to “use additional code to identify manifestation, such as: diabetic glaucoma (H40-H42).