New ICD-10 Codes for Diabetic Retinopathy and AMD
By Sue Vicchrilli, COT, OCS, Academy Director of Coding and Reimbursement, and Jenny Edgar, CPC, CPCO, OCS, Academy Coding Specialist
On Oct. 1, thousands of new and revised ICD-10 codes go into effect, including 368 that are relevant to ophthalmology. This article focuses on changes to the diabetic retinopathy and age-related macular degeneration (AMD) codes.
When ICD-10 launched in 2015, one of the biggest learning curves involved coding for diabetic retinopathy. If you aced that challenge, congratulations—but don’t relax. This year’s changes involve further restructuring of the diabetic retinopathy codes.
Laterality. Previously in ICD-10, the diabetic retinopathy codes were not identified by eye. That has now changed. Starting on Oct. 1, 2016, you will indicate laterality with a 1 (right eye), 2 (left eye), or 3 (bilateral) in the seventh position (see the red numerals in Tables 1 and 2).
Staging for PDR. The proliferative diabetic retinopathy (PDR) codes now identify stage in the sixth position (see the green numerals in Table 2).
Some aspects of these codes have stayed the same. Type 1 diabetes codes still start with E10, and type 2 with E11. Like last year, coding for nonproliferative diabetic retinopathy (NPDR) involves categorizing the diagnosis as mild, moderate, or severe and indicating whether or not macular edema is present (see Table 1). And you still use the same codes to indicate diabetes mellitus with no complications—E10.9 for type 1 and E11.9 for type 2—and those 2 codes don’t have laterality.
Prior to Oct 1, 2016, whether AMD was staged as wet (H35.32) or dry (H35.31), the ICD-10 codes didn’t specify eye. After Oct. 1, laterality is required when coding for AMD, in addition to staging.
Unlike diabetes, the eye indicator is in the sixth position (see red numerals in Tables 3 and 4) and staging is in the seventh position (see green numerals in Tables 3 and 4).
Use These Resources
Based on feedback from physicians and practice managers at Academy Codequest Coding Courses, ophthalmology seems to have been well prepared for the initial transition from ICD-9. As ICD-10 evolves, the Academy and AAOE will continue to support their members with a comprehensive range of resources, including:
If you are attending AAO 2016, consider attending some of the coding sessions that focus on ICD-10 (aao.org/programsearch).