Diabetic Retinopathy and Diabetic Macular Edema

Effective October 1, 2005, new codes have been created to separately identify the various stages of nonproliferating diabetic retinopathy and diabetic macular edema. In addition to these new codes, the inclusion terms diabetic macular edema and diabetic retinal edema that had been included under code 362.01 have been deleted. A new code 362.07, Diabetic macular edema, that includes diabetic retinal edema, has become effective. A special note is provided at code 362.07 that states code 362.07 cannot be used without one of the codes for diabetic retinopathy. Diabetic macular edema is only present with diabetic...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers a coding update involving diabetic retinopathy and diabetic macular edema, with emphasis on revised diabetes manifestation reporting and the organization of the related retinal disorder codes. It is relevant to coders, auditors, and clinicians working with ophthalmology and diabetes-related diagnosis coding, especially where retinopathy severity and macular edema are documented. The article also includes background clinical context, notes about code sequencing, and a coding example based on a diabetic eye evaluation.

Why This Topic Matters

Accurate reporting of diabetic eye complications depends on understanding the relationship between diabetes, retinopathy severity, and macular edema. This article helps readers recognize the affected code family and the documentation context in which those diagnosis codes are discussed.

Article Sections

  1. Coding update and effective date

    Introduces the coding changes that took effect and describes the affected diagnosis categories. It frames the revision in terms of diabetic eye complications and related ophthalmic manifestation coding.

  2. Clinical background on diabetic retinopathy and macular edema

    Summarizes the clinical progression of diabetic retinopathy and the general features of diabetic macular edema. This section provides context for understanding the diagnosis categories discussed later in the article.

  3. ICD-9-CM code changes and notes

    Presents the affected diabetes and retinal disorder code families along with the revised entries and note language. It also identifies the broader subcategory structure associated with diabetic retinopathy.

  4. Coding example

    Includes a brief case scenario involving diabetic retinopathy documentation and asks how it should be coded. The example illustrates the type of record information addressed by the article.

What You Will Learn

  • How the diabetic eye complication topic is organized within the relevant diagnosis code families
  • What kinds of clinical findings are discussed in relation to diabetic retinopathy and macular edema
  • How the article frames code revisions, sequencing notes, and manifestation reporting
  • What documentation context appears in the included coding example

Who Should Read This

  • Medical coders
  • Coding auditors
  • Physician documentation staff
  • Ophthalmology practices
  • Diabetes-related billing teams

Codes Discussed

  • ICD-9-CM: 250
  • ICD-9-CM: 250.4
  • ICD-9-CM: 250.5
  • ICD-9-CM: 250.50
  • ICD-9-CM: 362.0
  • ICD-9-CM: 362.01
  • ICD-9-CM: 362.03
  • ICD-9-CM: 362.04
  • ICD-9-CM: 362.05
  • ICD-9-CM: 362.06
  • ICD-9-CM: 362.07

Code Ranges Discussed

  • ICD-9-CM: 585.1-585.9
  • ICD-9-CM: 362.01-362.06

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