After October 1st, the 12-month grace period will end and your use of ICD-10 codes will need to be more specific and accurate or risk denied claims.   Fortunately, EHR technology has made coding with the new system much simpler but there are some changes that go into effect soon:


For Type II diabetes E11.9 be sure to add Z79.4 long-term insulin use and/or Z79.84 Long-term oral drug use

For all types of Diabetic Retinopathy (E11.3) add which eye for the 7th character (1 – RT, 2- LT, and 3 – BI) For example, Nonproliferative Retinopathy, mild, without macular edema was E11.329 and will now be E11.3293 with the 7th character indicating bilateral in this example.  Also, be sure to add Z79.4 long-term insulin use and/or Z79.84 Long-term oral drug use.

Primary Open-Angle Glaucoma (POAG)

POAG H40.11 is no longer considered bilateral and now you must add the eye in the 6th character (1 – RT, 2- LT, and 3 – BI) and the stage in the 7th like before.

  • 0 = stage unspecified
  • 1 = optic nerve abnormalities no visual field abnormalities
  • 2 = visual field abnormalities one hemifield, not 5 deg
  • 3 = visual field abnormalities both hemifields,and/or 5 deg
  • 4 = patient incapable of or no visual field yet

So POAG stage 1 in both eyes is now H40.1131.

Glaucoma in disease classified elsewhere (H42.) – code underlying condition first.  i.e. Lowe’s Syndrome E72.03, diabetic retinopathy E11.3

Age-Related Macular Degeneration (AMD)

The stage has been added as a 7th character to H35.31 Nonexudative AMD and H35.32 Exudative AMD.  The eye is indicated in the 6th character.  For example, early Dry AMD in both eyes is now H35.3131.

The stages of Dry:

  • 0 = stage unspecified
  • 1 = early
  • 2 = intermediate
  • 3 = advanced
  • 4 = advanced atrophic with subfoveal involvement

The stages for Wet:

  • 0 = stage unspecified
  • 1 = active choroidal neovascularization
  • 2 = inactive choroidal neovascularization
  • 3 = inactive scar

If the stage is different in each eye, use both codes.

Vascular Occlusion

Now severity is required for central retinal vein occlusion H34.81 and branch retinal vein occlusion H34.83.  The eye is indicated in the 6th character and the severity in the 7th.

Severity characters (7th place)

  • 0 = with macular edema
  • 1 = with retinal neovascularization
  • 2 = stable

For example, central vein occlusion in the right eye with macular edema is H34.8110

Amblyopia Suspect H53.04 has been added

It uses the 6th code to indicate the eye effected.  So Amblyopia Suspect left eye is now H53.042

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