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Insight into Coding Diabetic Eye Conditions

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Christy-Matheson

There are a variety of conditions that can impact individuals with diabetes.  People with diabetes are at greater risk for developing eye problems that could lead to blindness or serious deterioration of sight.  Age also plays a role in the progression of eye disease in individuals with diabetes.  Cataracts, glaucoma and retinopathy are the most common eye diseases that impact people with diabetes. The article below will discuss these conditions and offer tips for proper ICD-10-CM coding.

The table below identifies the broad ICD-10-CM Categories for Diabetes.

ICD-10 Code Category ICD-10 Description Coding Tips
E08* Diabetes mellitus due to underlying condition Code first the underlying condition

Use additional code to identify any insulin use

 

E09* Drug or chemical induced diabetes mellitus Code first poisoning due to drug or toxin, if applicable

Use additional code for adverse effect, if applicable, to identify drug

Use additional code to identify any insulin use

E10* Type 1 diabetes mellitus No additional code needed to identify insulin use
E11* Type 2 diabetes mellitus Use additional code to identify any insulin use
*indicates code category in range, look for additional digits

 

 

Cataracts and Glaucoma both have a high prevalence in people with Diabetes.  According to the National Institute on Health, people with diabetes are 2-5 times more likely of developing a cataract.  Cataracts are a cloudy appearance over the lens of the eye, preventing clear vision focus.   Glaucoma is a condition that occurs when intraocular pressure builds up in the eye and eventually pinches the blood vessels that supply the optic nerve, thus leading to vision loss and nerve damage.

When coding for diabetic eye conditions, the most prevalent condition related to ophthalmology that you will see is diabetic retinopathy.  Retinopathy is a general term that refers to disorders of the retina that are usually caused by diabetes.  The major differentiation with retinopathy is proliferative or nonproliferative.   Nonproliferative retinopathy is the most common form and occurs when small blood vessels in the back of the eye balloon and form pouches and become blocked.  There are three stages of nonproliferative retinopathy (mild, moderate, and severe) that denotes the patient’s progression through the disease as more blood vessels become blocked.  Proliferative retinopathy refers to more advanced retinopathy that has progressed to the point that blood vessels are completely closed off and new vessels are starting to form in the retina.  The new vessels can leak blood causing a hemorrhage of the vitreous and even pull the retina out of place, detaching it.

When coding diabetic retinopathy, there are several key elements of documentation that a coder should know in order to assign the most specific and correct code.  Below is a helpful checklist of key documentation:

Diabetes Type    
  Type 1  
  Type 2  
  Other Specified  
  Drug Induced  
Type of Reinopathy    
  Nonproliferative  
    ·         Mild
    ·         Moderate
    ·         Severe
  Proliferative  
  With or without Macular Edema  
  With or without traction detachment of retina  
  Laterality  
    ·         Right eye
    ·         Left eye
    ·         Bilateral
    ·         Unspecified eye
  Insulin Use  

 

 

 

 

 

 

 

 

 

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