Icd-10, Part 4: How To Code For Diabetic Retinopathy
Written By: Elizabeth Cottle, CPC, OCS, Rajiv R. Rathod, MD, MBA, Sue Vicchrilli, COT, OCS, and E. Joy Woodke, COE, OCS 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. What’s the Underlying Condition? According to ICD-10 instructions, physicians Continue reading >>
Type 2 Diabetes Mellitus With Unspecified Diabetic Retinopathy Without Macular Edema
E11.319 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Type 2 diabetes w unsp diabetic rtnop w/o macular edema This is the American ICD-10-CM version of E11.319 - other international versions of ICD-10 E11.319 may differ. Continue reading >>
- Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study
- Peripheral Edema and Diabetes
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
Type 2 Diabetes Mellitus With Unspecified Diabetic Retinopathy With Macular Edema
E11.311 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Type 2 diabetes w unsp diabetic retinopathy w macular edema This is the American ICD-10-CM version of E11.311 - other international versions of ICD-10 E11.311 may differ. A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should. A heterogeneous group of disorders characterized by hyperglycemia and glucose intolerance. A metabolic disorder characterized by abnormally high blood sugar levels due to diminished production of insulin or insulin resistance/desensitization. A subclass of diabetes mellitus that is not insulin-responsive or dependent (niddm). It is characterized initially by insulin resistance and hyperinsulinemia; and eventually by glucose intolerance; hyperglycemia; and overt diabetes. Type ii diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop ketosis but often exhibit obesity. A type of diabetes mellitus that is characterized by insulin resistance or desensitization and increased blood glucose levels. This is a chronic disease that can develop gradually over the life of a patient and can be linked to both environmental factors and heredity. Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without Continue reading >>
- Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study
- Peripheral Edema and Diabetes
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
Diabetic Retinopathy
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness.[1] It affects up to 80 percent of people who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.[5] Signs and symptoms[edit] Normal vision The same view with diabetic retinopathy. Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography) Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day. In the first stage which is called non-proliferative diabetic retinopathy (NPDR) there are no symptoms, the signs are not visible to the eye and patients will have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to see the back of the eye. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow). Macular edema in which blood vessels leak their contents into the macular regi Continue reading >>
Icd-10 Diagnosis Code E11.319
ICD-10: E11.319 Short Description: Type 2 diabetes w unsp diabetic rtnop w/o macular edema Long Description: Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema This is the 2018 version of the ICD-10-CM diagnosis code E11.319 Valid for Submission The code E11.319 is valid for submission for HIPAA-covered transactions. Code Classification Endocrine, nutritional and metabolic diseases (E00–E90) Diabetes mellitus (E08-E13) Type 2 diabetes mellitus (E11) Convert to ICD-9 Synonyms Advanced diabetic retinal disease Diabetic retinal microaneurysm Diabetic retinopathy Diabetic retinopathy associated with type II diabetes mellitus On examination - left eye background diabetic retinopathy On examination - right eye background diabetic retinopathy On examination - sight threatening diabetic retinopathy Peripheral circulatory disorder associated with diabetes mellitus Retinal arteriovenous dilatation Retinal microaneurysm Visually threatening diabetic retinopathy Diabetes Type 2 Also called: Type 2 Diabetes Diabetes means your blood glucose, or blood sugar, levels are too high. With type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth. You have a higher risk of type 2 diabetes if you are older, obese, have a family history of diabetes, or do not exercise. Having prediabetes also increases your risk. Prediabetes means that your blood sugar is higher than normal but not high enough to be called diabetes. The symptoms of type 2 diabetes appear slowly. Some people do not Continue reading >>
Type 2 Diabetes Mellitus Without Complications
Diabetes in pregnancy Diabetes mellitus diet education done Diabetes mellitus in the puerperium - baby delivered during current episode of care Diabetes mellitus type 2 Diabetes mellitus type 2 without retinopathy Diabetes type 2 Diabetes type 2 controlled with diet Diabetes type 2 on insulin Diabetes type 2, uncomplicated Diabetes type 2, without retinopathy Diabetic foot exam Diabetic foot exam done Dietary diabetic patient education Gestational diabetes mellitus Insulin treated type 2 diabetes mellitus Insulin-treated non-insulin-dependent diabetes mellitus Maturity onset diabetes mellitus in young Maturity onset diabetes of youth Maturity-onset diabetes of the young Nutrition therapy for diabetes type 2 done Nutritional therapy for diabetes mellitus type 2 Postpartum (after pregnancy) diabetes Preexisting diabetes mellitus during postpartum Preexisting diabetes postpartum (after childbirth) Type 2 diabetes mellitus Type 2 diabetes mellitus controlled by diet Type 2 diabetes mellitus without complication Type ii diabetes mellitus without complication Continue reading >>
Icd-10-cm And Cpt Changes In 2017
November/ December 2016 ICD-10-CM CHANGES The proliferation of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for 2017 is especially relevant for retina practices, particularly the codes found in Chapter 4.1 New diagnosis codes should be in use now (started October 1), and the Centers for Medicare and Medicaid Services (CMS) has stated that they should be used from October 1 through September 30, 2017. Codes that do not change will continue to be used going forward. CMS was lenient in 2016 in allowing the use of codes with the description unspecified. In ICD-10-CM jargon, unspecified means the laterality or specificity of the diagnosis was not noted in the chart, not that it is unspecified clinically. Practices can expect claim denials if unspecified codes continue to be used. Codes that are more helpful are now in the book, but they are not necessarily where you would expect to find them. For example, codes for combined traction and rhegmatogenous retinal detachments can be found in Chapter 4 (Endocrine, Nutritional and other Metabolic Diseases) under diabetes, not in Chapter 7 (Diseases of the Eye and Adnexa). Chapter 4 also contains codes for use when a disease process has been treated and for disease that is stable. It is important for all physicians in a practice to review these changes because billing, coding, and payment will depend on the necessary information being documented in the chart. GUIDELINES The following is not a comprehensive list of all the changes for this year. Practices are advised to purchase and review the 2017 book.1 Diabetes mellitus has been abbreviated as DM. All descriptors have been abbreviated. Indented codes on this list are read with the beginning descriptor of the prior code. The hyphe Continue reading >>
Type 2 Diabetes Mellitus E11- >
A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should. A heterogeneous group of disorders characterized by hyperglycemia and glucose intolerance. A metabolic disorder characterized by abnormally high blood sugar levels due to diminished production of insulin or insulin resistance/desensitization. A subclass of diabetes mellitus that is not insulin-responsive or dependent (niddm). It is characterized initially by insulin resistance and hyperinsulinemia; and eventually by glucose intolerance; hyperglycemia; and overt diabetes. Type ii diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop ketosis but often exhibit obesity. A type of diabetes mellitus that is characterized by insulin resistance or desensitization and increased blood glucose levels. This is a chronic disease that can develop gradually over the life of a patient and can be linked to both environmental factors and heredity. Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestati Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
- Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations
E11.319-349 Diabetic Retinopathy
The main goal of the diagnostic evaluation in a patient with diabetic retinopathy is to accomplish the following: Determine the presence or absence of diabetic retinopathy Identify and exclude differential diagnosis Determine if the retinopathy is clinically significant and/or vision threatening The severity of the symptoms or signs isvaried and dependson the level of control the patient has over their diabetes. Patients can present with the following abnormal symptoms: Floaters or dark spots in their field of view The retinal changes associated with diabetic retinopathy include the following: Used to assess visual function and determine the size of any associated visual field defects Visual field may be affected depending on the size and location of retinal hemorrhagingthe extent of the visual field defect depends on size of macular edema A two-dimensional ultrasonic scanning procedure used to produce cross-sectional images of the eye and orbit B-scan ophthalmic ultrasound can be used to assess internal structures of the eye when avitreous hemorrhageprevents proper visualization and examination of the retina The test results are used to determine whether the retina is attached or detached Diabetic retinopathy is classified into two types: 1. Non-proliferative diabetic retinopathy Change of diet, weight loss and incorporating exercise Managing any other medical conditions such as high blood pressure and high cholesterol can help reduce the risk Long term control of blood sugar either through oral medication or injection is important for preservation of vision, especially with no signs of diabetic retinopathy or the early stages of it Scatteredlaser treatment, also known as panretinal photocoagulation, can stop the leakage of fluid into the retina Vitrectomy This proced Continue reading >>
Icd-10-cm Diabetes Diag Codes
The discharge ICD-10-CM codes included in this spreadsheet are acceptable for use to answer "YES" to "Diabetes Mellitus" to complete the NHSN Operative Procedure Details. The definition excludes patients who receive insulin for perioperative control of hyperglycemia but have no diagnosis of diabetes. (reviewed 11012016) ICD-10-CM DIABETES DIAGNOSES CODES DESCRIPTIONS E10.10 Type 1 diabetes mellitus with ketoacidosis without coma E10.11 Type 1 diabetes mellitus with ketoacidosis with coma E10.21 Type 1 diabetes mellitus with diabetic nephropathy E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease E10.29 Type 1 diabetes mellitus with other diabetic kidney complication E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema E10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema E10.321 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E10.329 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E10.331 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E10.339 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E10.341 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E10.349 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E10.351 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema E10.359 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema E10.36 Type 1 diabetes mellitus with diabetic cataract E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
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Top Icd-10-cm Changes: Diabetes, Glaucoma And Macular Degeneration
On October 1, 2016, changes to ICD-10-CM coding were implemented. While all of the code changes applicable for optometry are important, a few of the major changes are discussed in this article. Diabetic Ocular Complication Codes The first major change in ICD-10-CM codes for 2017 is for diabetic ocular complication coding. All of the DM retinopathy code choices will now specify which eye is impacted. Several new codes for proliferative diabetic retinopathy were also added. Note that a code for oral diabetic medication use (Z79.84) was added and should be used when applicable. The existing code to designate insulin use (Z79.4) was retained. Keep in mind that not all injectable diabetic medications are considered insulin. If a patient is on both oral medication and insulin, both of these medication codes should be used. The new codes for diabetic retinopathy apply to all the code categories, but only the E11.3 code section is detailed in this article so be sure to review the other categories if you are using them for any particular patient. The other categories include E08.3, E09.3, and E10.3. E11.3 Type 2 diabetes mellitus with ophthalmic complications All of the subcategories under E11.3, with two exceptions, will require a 7th character to indicate which eye had retinopathy. One exception is E11.36 Type 2 diabetes mellitus with diabetic cataract. The other exception is E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication, but this code does require the use of an additional code to further describe the complication. The ICD-10-CM tabular listing for each of the following subcategories will require the following 7th character to be added as indicated by this statement under each subcategory: E11.32, E11.33, E11.34, and E11.35. As an example, all of Continue reading >>
Icd-10 Diabetes Codes Without Ocular Complications
Question: There is no code for diabetes type 1 or type 2 that includes "without ocular complications" (i.e., no diabetic retinopathy). The only available codes are E10.9 or E11.9, which do not seem correct. What diagnosis code should we submit when the patient has no ocular complications? Answer: You are correct that there is no specific code for “without ocular complications.” The best code to use in this case is either E10.9 or E11.9. These codes are appropriate because the taxonomy code included in the claim indicates the physician specialty. As ICD-10 evolves, we may see more specific codes in the future. Continue reading >>
Coding Q&a
CODING Q&A Diabetes Coding for ICD-10-CM SUZANNE L. CORCORAN, COE Coding and documentation for diabetes and especially diabetic eye disease have changed substantially with the implementation of ICD-10. Here are some considerations to keep in mind. Q. What are the major differences between ICD-9 and ICD-10 for diabetes? A. In coding diabetic eye disease, there are many changes. Instead of coding diabetes plus any ocular manifestations as separate codes, ICD-10 has introduced “combination codes” that describe the type of diabetes as well as any retinopathy and edema. In ICD-9, we coded diabetes as follows, with a fifth digit to identify the type of diabetes. 250.0_ Diabetes mellitus w/o mention of complication or manifestation 250.5_ Diabetes mellitus with ophthalmic manifestations • 0 – Type II, or unspecified type, not stated as uncontrolled • 1 – Type I [juvenile], not stated as uncontrolled • 2 – Type II, or unspecified type, uncontrolled • 3 – Type I [juvenile], uncontrolled When there was diabetic retinopathy, we coded also: 362.0 – Diabetic retinopathy • 362.01 – Background diabetic retinopathy • 362.02 – Proliferative diabetic retinopathy (PDR) • 362.03 – Nonproliferative diabetic retinopathy, NOS (NPDR) • 362.04 – Mild nonproliferative diabetic retinopathy (NPDR) • 362.05 – Moderate nonproliferative diabetic retinopathy (NPDR) • 362.06 – Severe nonproliferative diabetic retinopathy (NPDR) • 362.07 – Diabetic macular edema (DME) Suzanne L. Corcoran, COE, is executive vice president and founder of Corcoran Consulting Group, San Bernardino, CA, which specializes in coding and reimbursement issues for ophthalmic practices. Her e-mail is [email protected] In ICD-10, everything has changed. First, the concept o Continue reading >>
Icd-10 Doesn't Have To Be Intimidating
To help internists become even more comfortable with the new code set, ACP looks at how the codes are structured and how to cross-walk from old to new for some of the most common ones. The idea of a new code set should be familiar by now to internists. To help internists become even more comfortable with ICD-10, this column will answer questions that ACP has received from members by offering examples of the codes for common diagnoses. Q: What are the differences in the structures of ICD-9 versus ICD-10 codes? Are the code numbers random, or do they follow some type of order? A: ICD-10 uses 3 to 7 alphabetic and numeric characters and full code titles, but the format is very similar to that of ICD-9. ICD-10 uses codes that are longer (in some cases) than those of ICD-9, following a basic structure: characters 1-3 will now refer to the code category; characters 4-6 will cover clinical details such as severity, etiology, and anatomic site (among others) and are alphabetic or numeric and character 7 will serve as an extension when necessary and will be either alphabetic or numeric. For illustration, here are a few brief crosswalks from ICD-9 to ICD-10 coding. In ICD-9, headache is coded as 784.0; in ICD-10, it is coded as R51. ICD-9 uses 724.5 for backache, unspecified, while ICD-10 uses the following more specific codes: M54.9, dorsalgia, unspecified; M54.89, other dorsalgia; M54.6, pain in thoracic spine; M54.5, low back pain; and M53.3, sacrococcygeal disorders, not elsewhere classified. For atrial fibrillation, ICD-9 uses the code 427.31, while ICD-10 uses the following more specific codes: I48.0, paroxysmal atrial fibrillation; I48.1, persistent atrial fibrillation; I48.2, chronic atrial fibrillation; and I48.91, unspecified atrial fibrillation. Q: I've heard that ICD Continue reading >>
Background Diabetic Retinopathy
Approximate Synonyms Diabetes type 1 retinal edema Diabetes type 1 with macular edema and retinopathy Diabetes type 1 with retinopathy Diabetes type 2 with macular edema and retinopathy Diabetes type 2 with retinal edema Diabetes type 2 with retinopathy Diabetic retinopathy associated with type I diabetes mellitus Diabetic retinopathy associated with type II diabetes mellitus Diabetic retinopathy due to secondary diabetes mellitus Diabetic retinopathy with macular edema due to drug induced diabetes mellitus Diabetic retinopathy without macular edema due to drug induced diabetes mellitus DM 1 w diabetic retinal edema DM 1 W diabetic retinopathy DM 1 w diabetic retinopathy w macular edema DM 1 w nonproliferative diabetic retinopathy DM 2 W diabetic background retinopathy DM 2 w diabetic retinal edema DM 2 W diabetic retinopathy DM 2 w diabetic retinopathy w macular edema Drug induced diabetes with diabetic retinopathy Drug induced diabetes with macular edema Drug induced DM w diabetic retinopathy Drug induced DM w diabetic retinopathy w macular edema Macular edema and retinopathy due to type 1 diabetes mellitus Macular edema and retinopathy due to type 2 diabetes mellitus Nonproliferative diabetic retinopathy associated with Type 2 diabetes mellitus Nonproliferative retinopathy due to type 1 diabetes mellitus Retinal edema due to type 1 diabetes mellitus Retinal edema due to type 2 diabetes mellitus Retinopathy with macular edema due to secondary diabetes mellitus Secondary diabetes with retinopathy Secondary diabetes with retinopathy with macular edema Secondary DM w diabetic retinopathy Secondary DM w diabetic retinopathy w macular edema Continue reading >>
