Check out your version of ICD-9. In the conventions, it clearly states that manifestation codes (such as Diabetic retinopathy) are to be coded as shown in the guidelines and alphabetic index. The same conventions are again stated in the tabular. ICD-9 Guidelines are followed, irrespective of the site of service or provider of service.
You may also reference Faye Brown (AHA Publications) on this matter and AHA Coding Clinic.
Hope this helps.
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