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N O V E M B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
betes, (2) the existence of retinopathy (as well as the type and severi-
ty) and (3) whether the patient has macular edema. For example,
Type 1 diabetes mellitus without complications is coded as E10.9,
while E10.349 represents Type 1 diabetes mellitus with severe non-
proliferative diabetic retinopathy, without macular edema. Note that
since there is no laterality indicated in this code, the patient could
have a different type in each eye.
Coders should pay special attention when coding a diabetic condi-
tion to ensure that it's specific enough and uses the correct code for
each characteristic of the diabetes. The American Academy of
Ophthalmology has created a diabetes decision tree to help in this
regard (osmag.net/5EmKRx).
• X placeholders. Glaucoma staging and injury and trauma diagnoses
require a 7
th
character in ICD-10. However, not all ICD-10 codes that
require a 7
th
character have a 6
th
character, and they may even be
missing a 5
th
. To ensure that the coding is in the correct position, you
use an X placeholder.
If you're using a code that's only 5 digits long but requires a 7
th
character, place an X between the 5
th
and 7
th
character. For exam-
ple, to code for primary open-angle glaucoma (POAG), moderate
stage, you would use the code H40.11X2, with the X in the 6
th
char-
acter spot. H40 represents glaucoma, 11 indicates POAG and since
the 2 (which indicates moderate stage) must be in the 7
th
position,
you place the X in the 6
th
spot. Without the correct use of this place-
holder, your claim could be delayed or denied.
• Laterality. As seen with the diabetes example above, not all codes in
ICD-10 include laterality. So, it's imperative to know when an addition-
al character is required. While some codes ask you to add the laterali-
ty — which you do by tacking on a 1 for the right side, 2 for the left
side and 3 for bilateral to the end of the code — others don't require
