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    ICD-10, Part 4: How to Code for Diabetic Retinopathy

    By Elizabeth Cottle, CPC, OCS, Rajiv R. Rathod, MD, MBA, Sue Vicchrilli, COT, OCS, and E. Joy Woodke, COE, OCS
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    Note: The article below was published on June 2014. In 2016, there was a restructuring of the diabetic retinopathy codes, as discussed in "New ICD-10 Codes for Diabetic Retinopathy" (September 2016, EyeNet). 

    Finding the ICD-10 codes for diabetic retinopathy can be tricky. They are not listed in Chapter 7, Diseases of the Eye and Adnexa (H00-H59), but are in the diabetes section (E08-E13) of Chapter 4, Endocrine, Nutritional and Metabolic Diseases.

    Retinal complications. To further confuse matters, the most common retinal complications are in Chapter 7, not Chapter 4. Examples include vitreous hemorrhage (H43.1-), traction detachment of retina (H33.4-), and rubeosis iridis (H21.1-).

    New options. ICD-10 features codes for diagnoses that don’t currently have codes. These include drug- or chemical-induced diabetes mellitus (E09.-); gestational diabetes (Q24.4-); neonatal diabetes mellitus (P70.2); and postpancreatectomy, postprocedural, or secondary diabetes mellitus (E13.-).

    Changes in Documentation

    Some terms that you’re using in charts—such as “NIDDM,” “controlled,” and “uncontrolled”—will be obsolete when ICD-10 starts on Oct. 1, 2015.

    Instead, diabetes documentation should address the following questions: Is it type 1 or type 2? Is there diabetic retinopathy? If so, is it proliferative or nonproliferative? If nonproliferative, is it mild, moderate, or severe? Is there macular edema?

    Preparedness tips. To help you work through that series of questions, the AAOE has developed a decision tree that you can laminate and keep for reference at the coder’s desk. Download it at www.aao.org/icd10. You also should update your intake form so that staff can capture the type of diabetes.

    Insulin use? Submit Z79.4 as supporting documentation indicating any insulin use.

    ICD-10 Codes for Diabetes 

    What’s the Underlying Condition?

    According to ICD-10 instructions, physicians should first code the underlying condition. Examples include congenital rubella syndrome (P35.0), Cushing syndrome (E24.-), cystic fibrosis (E84.-), malignant neoplasm (C00-C96), acute pancreatitis (K85.-), and other diseases of the pancreas (K86.-).

    However, under ICD-9, payers don’t require you to code the underlying condition, so it is doubtful that they will mandate this under ICD-10. But just in case they do, consider updating the review of systems (ROS) to include that information.