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  • Diabetes With Macular Edema ICD-10 Coding

    Question: When filing a claim to a commercial payer for a patient with diabetes, are we required to bill the diabetes and macular edema separately like ICD-9? If so, which ICD-10 codes should we submit?

    Answer: ICD-10 combined the diabetes, retinopathy, severity and edema, so it is now one code instead of a possibility of three. For example, E11.3511 is type 2 diabetes, proliferative retinopathy with macular edema, right eye. This is the only code that would be submitted whether to federal or commercial payers.

    Learn more in the ICD-10 for Ophthalmology and Retina Coding and Diabetic ICD-10 Decision Trees