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Diabetes and the ICD-10

A helpful example to make the switchover a piece of cake

JOHN RUMPAKIS, O.D., M.B.A.

While the very thought of the ICD-10 strikes fear into the hearts and minds of every physician, there seems to be the most anxiety surrounding the coding of systemic disease with ocular sequelae. Of course, the most prevalent disease that comes to mind for optometrists is diabetes.

As we discuss this, please keep in mind that as with the ICD-9 system, ICD-10 will require you to place the specific type of systemic disorder in the primary diagnosis slot on your CMS-1500 form or its equivalent, and any ocular sequelae in subordinate slots. So it will be very critical to be familiar with these systemic codes.

Here, I provide an example of how to determine the proper classification and coding for diabetic retinopathy.

Classification

We know that most ophthalmic codes are found in Chapter 7, “Eye and Adnexa.” But practices will need to become very familiar with Chapter 4 as well, where diabetes falls under “Endocrine, Nutritional and Metabolic Diseases.”

This is an important departure from the ICD-9 as the ICD-10 is organized by base disease first, then appropriate sequelae, and the base disease determines the chapter in which the diagnosis would be found. (See “Broad Classifications of Diabetes: ICD-9 vs. ICD-10,” page 53.)

An ICD-10 code is read from left to right, with each character providing additional granularity about the disease and the specific sequelae.

Coding

Once we classify the specific type of diabetes a patient may have, we can now begin to code the specific ocular sequelae related to the systemic disorder. Let’s look at how a code is structured for diabetic retinopathy. (See “Diabetic Retinopathy ICD-10 Code.”)

As illustrated in the example below, if we follow the ICD-10 structure by reading from left to right, we can easily see how each sequential character provides increasingly more detail about the specific diagnosis, starting with the systemic disease classification. Reiterating what was stated earlier, you can clearly see that the ocular disease component of diabetes begins with the systemic classification first (before the decimal), and then the ocular sequelae being described subsequently.

Diabetic Retinopathy ICD-10 Code

Additional considerations

Other things to note with regard to diabetic coding:

• Always start with systemic condition, then type 1 or 2. If retinopathy is found, is it proliferative or nonproliferative? If nonproliferative, is it mild, moderate or severe? Is there macular edema or not?

• When billing special ophthalmic tests, be sure to also link the procedure to the systemic diagnosis as well as to the ocular diagnosis.

• All retinal complications will be located in Chapter 7 (the eye chapter).

• Use code Z79.4 as supporting documentation indicating any insulin use.

A sweet ending

With a little practice and logical thinking, coding for both diabetes and its ocular sequelae will be a piece of cake (sugar-free, of course!). OM

DR. RUMPAKIS IS FOUNDER, PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. E-MAIL HIM AT JOHN@PRMI.COM OR VISIT TINYURL.COM/OMCOMMENT TO COMMENT ON THIS ARTICLE.