Manifestation Coding
Including the 2006 ICD-9 changes to codes for
diabetic retinopathy.
CARLA
MACK, O.D.
My last article addressed the fundamentals of correct diagnostic coding. This month, I'll focus specifically on diagnostic coding for underlying conditions and manifestations of diseases, such as diabetes. A disease manifestation is an expression or associated disorder of a disease process, but is not the primary disease. Your coding should reflect this. This is also referred to as mandatory multiple coding and requires that you report the primary disease as the primary diagnosis and the manifesting disease as the secondary diagnosis.
| Ocular Manifestations of Diabetes Mellitus | |
| 250.5X | Diabetes with ocular manifestations |
| Additional code to identify manifestation: | |
| 369.00-369.9 | Blindness |
| 366.41 | Diabetic cataract |
| 365.44 | Glaucoma associated with systemic syndromes |
| 362.83 | Retinal edema |
| Diabetic retinopathy | |
| 362.01 | Background diabetic retinopathy |
| Diabetic retinal microaneurysms | |
| Diabetic retinopathy NOS (not otherwise specified) | |
| 362.02 | Proliferative diabetic retinopathy |
| 362.03 | Nonproliferative diabetic retinopathy |
| 362.04 | Mild nonproliferative diabetic retinopathy |
| 362.05 | Moderate nonproliferative diabetic retinopathy |
| 362.06 | Severe nonproliferative diabetic retinopathy |
| 362.07 | Diabetic macular edema* |
|
*Code 362.07 must be used in conjunction with a code for diabetic retinopathy 362.01-362.06. | |
One or two?
The numeric or tabular listing of diagnostic codes for disorders of the eye and adnexa in the ICD-9 book begins with 360.00 (disorders of the globe), and ends with 379.99 (unspecified disorders of the eye). Italicized notes and instructions throughout this section will help you determine which diagnostic codes are manifestations of another disease process and require two diagnostic codes for accurate coding. Manifestation codes are also highlighted in blue for quick reference.
Diabetes
As primary eyecare providers, we play a significant
role in diagnosing and managing ocular manifestations of diabetes. We therefore
need a thorough understanding of coding for diabetes and ocular disorders associated
with the disease. On October 1, 2005, additional codes 362.03 through 362.07 were
added to further specify diabetic retinopathy. You can start using these immediately
when billing Medicare. The ICD-9 book provides detailed descriptions of proper notation
for diabetes diagnostic codes, which can be found in the tabular listing starting
with 250. Diabetic diagnosis codes must be specified to the fifth digit, indicating
the type of diabetes and whether it's under control. The fourth digit indicates
the manifestation.
| Sample of Ocular Manifestations Codes | |
| 362.0X | Diabetic retinopathy |
| Code first diabetes (250.5X) | |
| 365.41 | Glaucoma associated with chamber angle anomalies |
| Code first associated disorder as: | |
| Axenfeld's anomaly (743.33) | |
| Reiger's anomaly (743.55) | |
| 366.41 | Diabetic cataract |
| Code first diabetes (250.5X) | |
| 372.31 |
Rosacea conjunctivitis |
|
|
Code first underlying rosacea dermatitis (659.3) |
|
374.51 |
Xanthelasma |
|
|
Code first underlying condition (272.0-272.9) |
Ocular manifestation
Once you determine the appropriate fourth and fifth digit for the diabetic code, refer to the additional instructions within the tabular listing to guide you to the appropriate secondary ocular manifestation code.
Remember the mandatory multiple coding rule when recording ocular manifestations of systemic disease. The primary diagnostic code refers to the disease process and the secondary diagnostic code designates the manifesting disease process. Use the most up-to-date ICD-9-CM book (version 2006) not only as a reference for specific ICD-9 diagnostic codes, but also for valuable information for accurate and efficient coding.
If you haven't ordered your
2006 ICD book yet, online resources such as http://icd9cm.chrisendres.com are available
to keep you current. OM
DR. MACK IS DIRECTOR
OF CLINICS AT THE OHIO STATE UNIVERSITY COLLEGE
OF OPTOMETRY. SEND E-MAIL TO CMACK@OPTOMETRY.OSU.EDU.
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