Coding, Classification & Reimbursement

Diabetes and cataracts

  • 1.  Diabetes and cataracts

    Posted 05-25-2017 08:52
    In the 4th qtr 2016 a coding clinic was released stating that:

    Diabetic cataract
    ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2016 Pages: 142-143 Effective with discharges: October 1, 2016
    We have previously been extensively trained that the diabetic cataract is rare, and may occur with rapid onset in Type I diabetics. Coding Clinic for ICD-9- CM previously informed us that the type of cataract more commonly found in adult diabetic patients is the age-related cataract which is not classified as an ocular manifestation of diabetes. The new "With" guidelines instruct us to link any condition indented under the word "with" to diabetes. In this guideline, all cataracts in diabetic patients are diabetic cataracts. Is there a change in understanding of the pathophysiology of the diabetic cataract, and if so, are all cataracts in diabetic patients now considered diabetic cataracts?
    The advice published in Coding Clinic for ICD- 9-CM for diabetic cataracts dates back to 1985. Based on the revised guideline and changes in the understanding of the relationship between diabetes and cataracts, cataracts in diabetic patients should be coded as linked conditions. Cataracts are considered a major cause of visual impairment in diabetic patients as the incidence and progression of cataract is elevated in patients with diabetes mellitus. Several clinical studies have shown that cataract development occurs more frequently and at an earlier age in diabetic compared to non-diabetic patients.

    Am I interpreting this correctly that any patient with cataracts and diabetes we should be using the E11.36 Type 2 Diabetes Mellitus with diabetic cataracts even if the physician states it is an age related cataract?  Should we also be adding a separate code for the specific type of cataract?

    What is your interpretation of this guidance?
    Thank you!

    Monica Evans
    Coding Educator

  • 2.  RE: Diabetes and cataracts

    Posted 05-26-2017 05:46
    Yes, that is the current undetstanding.  Any condition found under "dm with" is coded as such.  As the index does not make a distinction between "diabetic" cataract and other types of cataracts one may also ask would it be incorrect to code E10.39/ E11.39 with opposed to E10.36 E11.36 alone.

    [Annetter] [Hansen] CPC, COC, CCS, CCS-P
    [Sr. Coder]

  • 3.  RE: Diabetes and cataracts

    Posted 05-26-2017 11:36
    Dear Monica,

    In the particular scenario that you posted, based on the documentation it seems that the patient's cataracts are age related and not diabetes related. If that is the case I would code the diabetes and the cataracts separately. If the documentation would support that the cataracts are related to the diabetes, then I would code it as such. The coding guidelines are just making you aware that cataracts are a severe complication of diabetes and this should be indicated in the documentation if the exam warrants it. Not every diabetic patient has cataracts and not every cataracts patient has diabetes and even if a patient has both it does not mean that they are related to each other.

    Remember let the documentation guide you and only code what is written. Any confusion or questions should be queried.

    Jodi Miller, RHIT, CCS

    Jodi Miller, RHIT, CCS