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Posted By Amanda on 07-08-2002, 20:46:00 in Ophthalmology
Help! If a doctor write CSME or Macular Edema what dx would you use? In the
ICD-9 book it states 362.83 for Macula Edema and for diabetic macula edema
to code using the diabetic codes.

So how would I know which to chose? If the patient is diabetic pick that
one? I didn't think it would be that easy?

Comments (4)
Posted By Amanda on 07-09-2002, 15:40:00
Posted By douglas on 07-09-2002, 15:37:00
I'm not sure what you mean by 3 choices. Anyway:

Patient with diabetes comes to doctor for retina exam, no diabetic
retinopathy is found. Then code either 250.00 or 250.01 depending on
whether it is type 1 or type 2 diabetes.

Diabetic patient is examined and is found to have diabetic retinal edema.
You use two codes: 362.83 AND one of the two diabetes codes, 250.50 or
250.51, depending on whether it is type 1 or type 2 diabetes (unless the
patient is stated to have uncontrolled diabetes, in which case use the
correct 5th digit). Some carriers (and correct coding) says you code the
"diabetes with ocular complications" (250.5X) first and the retinal edema
second (cause first, manifestation second), but other carriers want it the
other way around; and some coders agree that it makes more sense for an
ophthalmologist to code the retina diagnosis first, especially when there is
treatment carried out (like laser) that is directed at the retinal edema,
not the underlying diabetes.

If the patient has cystoid macular edema, say following cataract surgery,
then 362.53. Diabetes is not an issue.

If the patient has macular edema, not cystoid, not due to diabetes, then
362.83 all by itself.

If the patient happens to be diabetic, the doctor will have to tell you
whether he thinks it is diabetic edema (362.83 + 250.5X) or non-diabetic
cystoid macular edema (362.53). He may say he isn't sure (in other words,
the macula has edema and he's not sure whether diabetes caused it or not, or
whether it is "cystoid" in nature), then I would use 362.83 all by itself as
a somewhat less specific code. He may legitimately not be sure which it is,
and honestly it really is a non-consequential matter for the office visit
billing claim and not worth sweating in that instance.

Summary: 362.53 if the word "cystoid" comes up, or the abbreviation CME.
Otherwise, use 362.83. If the patient has diabetes as the cause for the
edema, use 362.83 plus a diabetes code, 250.5X.
Posted By Amanda on 07-09-2002, 13:05:00
Ok! In the dx book it states diabetic mac edema to use the 250.__ and 362.__
codes. So I would say that we have 3 choices.

Posted By douglas on 07-08-2002, 22:24:00
I believe 362.53 is usually used for what physicians call cystoid macular
edema, while 362.83 is used for other types of retinal edema, for example
that due to diabetes.

Ask the doctor to clarify which he means. You shouldn't have to read his
mind, but tell him these are the two choices for macular edema, and you need
to know which does he mean. He should learn in the future to be specific
about which he intends when he writes down the diagnosis of macular edema.
Probably he should write "CME" when he means 362.83, and "Macular Edema
diabetic" when that's (362.83) what he means, also telling you whether it is
type I or type II diabetes so you can code 250.50 or 250.51 as appropriate
(or rarely 250.52 or 250.53, if the diabetes is uncontrolled and so stated).

Whenever he means neither of the above ("cystoid" or "diabetic"), but any
other type of macular edema, then 362.83 would seem the proper choice, but
without the diabetes code, of course.

Douglas R. Anderson
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