The health care system will roll out additional ICD-10 coding changes this October. As a result, you’ll see many changes to diabetes coding that greatly impact ophthalmology.
Here’s a review of some brand-new codes, plus some revisions made based on specialty society feedback about how some codes were structured.
Diabetes and Laterality
Beginning Oct. 1, diabetes diagnosis coding requires laterality, which is signified by a seventh and final character — 1- Right, 2- Left or 3- Bilateral.
The laterality requirement affects everything from E08.32- Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema to E13.359- Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema.
Here are a few examples of laterality in some of the most commonly used diabetes codes in ophthalmology.
E10.351 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema has been expanded to:
- E10.3511 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E10.3512 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E10.3513 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema has been expanded to:
- E11.3511 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E11.3512 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
In addition, a new code, R73.03 Prediabetes, will be used in place of R73.09 Other abnormal glucose.
Impact on Coding Proliferative Diabetes
The changes include a new code set to define proliferative diabetes in greater detail. This set includes new language — such as “stable proliferative diabetic retinopathy,” “traction retinal detachment involving or not involving the macula” and “combined traction retinal detachment with rhegmatogenous retinal detachment.”
Here are a few examples:
E10.3521 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
- A “2” as the seventh character signifies the left eye; a “3” signifies bilaterality.
E13.3533 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
- A “1” as the seventh character signifies the right eye; a “2” signifies the left eye.
E10.3542 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
- A “1” as the seventh character signifies the right eye; a “3” signifies bilaterality.
E10.3553 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
- A “1” as the seventh character signifies the right eye; a “2” signifies the left eye.
E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
- A “2” as the seventh character signifies the left eye; a “3” signifies bilaterality.
Because each eye may have its own unique diagnosis, remember to link both eyes to the correct exam. The same goes for performing tests or surgical procedures — be sure to link to the correct diagnosis to ensure correct claims processing.
Additional Resources
ICD-10 will of course continue to evolve over the years as it becomes more specific based on your patients’ conditions.
Use the Academy’s wide range of print and online resources to stay informed, avoid costly coding errors and appropriately maximize reimbursement:
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About the author: Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series. 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 Practice Management Express, Ophthalmic Coding Coach and Ophthalmic Coding series.