Diabetic Retinopathy ICD-10-CM codes

Diabetic retinopathy is never coded to H35. The diabetes categories carry combination codes in the .3- subcategory: E11.3- for Type 2, E10.3- for Type 1, and the same structure in E08, E09, and E13. The fifth character is severity: 1 unspecified retinopathy, 2 mild nonproliferative, 3 moderate nonproliferative, 4 severe nonproliferative, 5 proliferative. The sixth character is macular edema: 1 with, 9 without. The seventh character is laterality: 1 right, 2 left, 3 bilateral, 9 unspecified. The unspecified retinopathy codes E11.311 and E11.319 stop at six characters and carry no laterality.

E11.319 (Type 2 diabetes with unspecified diabetic retinopathy without macular edema) is the code when the record says only diabetic retinopathy. E11.3293 is mild NPDR without macular edema, bilateral; E11.3513 is proliferative retinopathy with macular edema, bilateral. Proliferative retinopathy has extra sixth characters for traction retinal detachment involving the macula (2), not involving the macula (3), combined traction and rhegmatogenous detachment (4), and stable proliferative retinopathy (5).

Diabetic macular edema that has resolved after treatment is E11.37X- with laterality in the seventh position. Diabetic cataract is E11.36 and other ophthalmic complications are E11.39. Because the word with in the index links diabetes to retinopathy, a diabetic patient documented with retinopathy is coded to E11.3- unless the provider states the retinopathy has another cause; in that case use H35.0- for the retinopathy and E11.9 for the diabetes.

Do not add H35.81 (retinal edema) or an H35.0- background retinopathy code to a diabetic retinopathy combination code. Add Z79.4 for long-term insulin use or Z79.84 for oral hypoglycemics with Type 2 codes when applicable. Assign a separate code for each eye when the eyes differ in severity.