Article Date: 10/1/2007

A Quick Coding Guide for Diabetic Eye Findings

A Quick Coding Guide for Diabetic Eye Findings

This chart will help you determine which code to use based on clinical diagnosis.


I was recently approached to consult for a commercial firm that had been engaged by a pharmaceutical company to explore various market aspects for treating eye findings related to diabetes mellitus. The challenge was in presenting the coding/reimbursement issues to essentially lay people within a limited time and resource framework. The result was an approach using a clinical entity (diabetes and the related eye findings) as a starting point, rather than the standard method of teaching reimbursement by procedure and diagnosis codes as the basis.

Riva Lee Asbell is the principal in Riva Lee Asbell Associates, an ophthalmic reimbursement firm in Philadelphia. She can be reached through her Web site at


The main eye diseases resulting from diabetes mellitus were identified as diabetic retinopathy (DR), clinically significant macular edema (CSME), vitreous hemorrhage (VH), retinal detachment (RD) and proliferative vitreoretinopathy (PVR), neovascular glaucoma (NG), and diabetic cataract (because this basically falls into the cataract surgery category it is not included in this review).

In the hopes that this approach might prove useful to retinologists and their practices, it is herewith presented (Table). RP

CPT codes copyright 2007 American Medical Association.

ICD-9-CM codes copyright 2007 Practice Management Information Corporation and Word Health Organization.

Retinal Physician, Issue: October 2007