With ICD-10 implementation only a few months away, the American Academy of Ophthalmic Executives has received a number of interesting questions about ICD-10 coding nuances. One of the main concerns is how to code diabetes correctly. Indeed, coding for diabetes has undergone the most significant changes that physicians will see. Here are a few tips to get you on the right track.
1. How you state it in the chart matters. Current documentation of noninsulin-dependent diabetes mellitus does not translate to ICD-10. Therefore, language such as “controlled” or “uncontrolled” and “juvenile-onset” or “adult-onset” has become obsolete. Type 1 and Type 2 are the preferred, distinguished by the use of insulin.
According to Gordon Johns, MD, author of ICD-10-CM for Ophthalmology, “Type 1 is a result from a lack of insulin production, whereas type 2 is a result of insulin resistance.” He adds, “Clarification may be needed from an endocrinologist to determine which type is appropriate.” And while insulin use is more common in type 1, it may also be used in type 2. For ICD-10, record insulin separately using code Z79.4.
2. Choose a diagnosis code carefully. Instead of potentially indicating three codes on the claim, we now have one code. This single diagnosis now lists (1) the type of diabetes, (2) the existence of retinopathy (as well as the type and severity) and (3) whether or not the patient has macular edema.
E10.9 Type 1 diabetes mellitus without complications
E10.349 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy, without macular edema
E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy, with macular edema
E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy, with macular edema
To help members code correctly, AAOE has created a downloadable and printable Diabetes Physician Decision Tree that indicates what questions to ask to determine the correct code.
3. Remember that not every ICD-10 diagnosis will include laterality. As you can see, the codes listed above do not include an additional character for right, left or both eyes. Because diabetes does not include laterality, billing unilateral diagnostic tests and procedures can become tricky. When you perform these services, make sure to appropriately append the correct diagnosis.
Here’s an example. A patient presents with type 1 diabetes, and the findings include nonproliferative mild retinopathy without macular edema in the right eye (E10.329) and proliferative retinopathy with macular edema in the left eye (E10.351). You order bilateral fluorescein angiographies and fundus photos. How would you code these tests?
92235, RT- E10.329
92235, LT- E10.351
92250- E10.329, E10.351
Have ICD-10 questions of your own? Send them to firstname.lastname@example.org. For more ICD-10 answers, visit the AAOE coding blog.
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About the authors: Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Coding Bulletin, Ophthalmic Coding Coach and Ophthalmic Coding series. Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She oversees the Academy’s Chart Auditing Service and is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series.