ICD-10 and Coding Diabetes
The ICD-10 radically alters the way diabetes is evaluated and recorded. Setting aside decades of established nomenclature, the codes eliminate the use of former descriptives “juvenile” and “adult” onset, and moves simply to "Type 1" and "Type 2", with the distinction between the two being the use of insulin.
As you adapt to ICD-10 codes, you will see the specificities that are apparent in the thought processes behind classifying diabetes-related visions issues. Essentially, the coding combinations reflect the type of the disease, the body system affected and the complications that are affecting the body system.
Causes and Types:
Diabetes has multiple causes (genetics, lifestyle challenges, other conditions that affect the system, etc.) that are classified according to those causes (T1D, T2D, gestational, due to an underlying condition, etc.). The ICD-10 attempts to capture those causes as succinctly as possible. Note that the distinction between T1D and T2D is if or how insulin is used.
New patients may have a diagnosis that doesn’t declare whether they aren't producing insulin at all (T1D) or if they don’t adequately manage the insulin they do produce (T2D). If there’s doubt, an endocrinology assessment may be needed to assure that the correct diagnosis and codes are applied.
Ophthalmic Diagnosis Specifications:
Although ophthalmologists are addressing the vision-specific complications, how diabetes is affecting, and being managed in, other parts of the body can also be relevant to ocular treatment. In the ICD-9, three ophthalmic codes were provided as potential options for diagnostic indicators. The ICD-10 has combined those three together as a single code that includes the type of diabetes; the existence of, type and severity of any associated retinopathy, and the presence or absence of macular edema. Four independent code numbers now describe those related factors within the single diagnosis code, as follows:
E10.9 T1D without complications;
E10.349 T1D with severe nonprolific diabetic retinopathy, without macular edema;
E11.321 T2D with mild nonprolific diabetic retinopathy, with macular edema; and
E11.351 T2D with prolific diabetic retinopathy, with macular edema.
The AAOE has created a “Diabetes Physician Decision Tree” Graphic that will walk you through the process to identify the patient factors that will inform the diagnosis coding.
A Lateral Challenge:
The ICD-10 introduces lateral (right and left) codes that were not used in the ICD-9. The ICD-10 for diabetes does not specify a lateral character, although ocular diabetic manifestations can create differing diagnoses in each eye, each of which would require a different code. Testing and treatment options would differ for each eye as well. Consequently, coding for each eye will also be individual for that eye.
Additional Aspects of the ICD-10, Diabetes and Ophthalmology:
No Population is Immune:
The new system of evaluating the impact of diabetes on society takes into account the statistics that have been developing over the past 30 years. These data indicate that any type of diabetes can develop at any stage of life, and that genetic, racial and gender specificity plays a much larger part in the occurrence of the disease than was previously thought.
In 2014, 29.1 million Americans were diagnosed with diabetes, totaling 9.3% of the population. An approximate 8.1 million (27.8% of the entire population) are believed to have undiagnosed diabetes:
- Not surprisingly, older people develop the disease more than do young people, often as a result of a combination of less-than-active lifestyles, diet choices and the slow degrading of bodily functions caused by aging. As much as 25.9% of the population aged 65 and over have a diabetes diagnosis.
- Men suffer the issue more than women over the general population, with 13.6% of American men, compared to only 13.4 of American women.
- For adults under age 65, approximately:
15.9% of American Indians and Alaskan Natives carry the disease,
13.2% of Blacks,
12.8% of Hispanics,
9.0% of Asian Americans and
7.6 of white Americans.
- In 2012, more than 1.7 million people over 20 years were diagnosed with the disease, and an estimated 86 million Americans were identified as having prediabetes.
Managing Diabetes Will be a Bigger Problem in the Future:
A 2004 study defined the coming explosion of diabetes diagnoses as an “epidemic” based on the rising rates of obesity in the global population. The study projects that the number of diabetics in the world wide population will rise from 171 million in 2000 (2.8%) to over 366 million (4.4%) by 2030. The authors comment that the lifestyle choices of people of all ages that contribute to the epidemic will likely demonstrate that the projection is an underestimate of the true scope of the problem.
The study evaluated statistics from the World Health Organization and accounted for the 191 countries that were then current members of that group. Developed countries had lower all rates than developing countries. The U.S. had an estimated 17.7 million diabetics in 2000, and that number was projected to rise to over 30 million in 2030. The main factors for the rise globally were considered to be obesity, aging, and urbanization. While much of America is urbanized, certainly the obesity and aging baby boomer numbers support the supposition that America will experience a similar diabetes epidemic as that of the rest of the world.
Not all people who have diabetes develop eye problems, but for those that do, the condition makes treatment of those problems more complex. The ICD-10 seeks to assist Ophthalmologists to comprehensively diagnose, treat and report diabetes-related ocular challenges. By doing so, the program intends to ensure that patients get the care they need, doctors are compensated for providing appropriate care, and the United States can contribute meaningfully to global health statistics.