Article Date: 12/1/2005

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Manifestation Coding
Including the 2006 ICD-9 changes to codes for diabetic retinopathy.

My last article addressed the fundamentals of correct diagnostic coding. This month, I'll focus specifically on diagnostic coding for underlying conditions and manifestations of diseases, such as diabetes. A disease manifestation is an expression or associated disorder of a disease process, but is not the primary disease. Your coding should reflect this. This is also referred to as mandatory multiple coding and requires that you report the primary disease as the primary diagnosis and the manifesting disease as the secondary diagnosis.

Ocular Manifestations of Diabetes Mellitus
   250.5X Diabetes with ocular manifestations 
Additional code to identify manifestation:
   369.00-369.9  Blindness
   366.41 Diabetic cataract
   365.44 Glaucoma associated with systemic syndromes
   362.83 Retinal edema
Diabetic retinopathy
   362.01 Background diabetic retinopathy
  Diabetic retinal microaneurysms
  Diabetic retinopathy NOS (not otherwise specified)
   362.02 Proliferative diabetic retinopathy
   362.03 Nonproliferative diabetic retinopathy
   362.04  Mild nonproliferative diabetic retinopathy
   362.05 Moderate nonproliferative diabetic retinopathy
   362.06  Severe nonproliferative diabetic retinopathy
   362.07 Diabetic macular edema*

*Code 362.07 must be used in conjunction with a code for diabetic retinopathy 362.01-362.06.

One or two?

The numeric or tabular listing of diagnostic codes for disorders of the eye and adnexa in the ICD-9 book begins with 360.00 (disorders of the globe), and ends with 379.99 (unspecified disorders of the eye). Italicized notes and instructions throughout this section will help you determine which diagnostic codes are manifestations of another disease process and require two diagnostic codes for accurate coding. Manifestation codes are also highlighted in blue for quick reference.


As primary eyecare providers, we play a significant role in diagnosing and managing ocular manifestations of diabetes. We therefore need a thorough understanding of coding for diabetes and ocular disorders associated with the disease. On October 1, 2005, additional codes 362.03 through 362.07 were added to further specify diabetic retinopathy. You can start using these immediately when billing Medicare. The ICD-9 book provides detailed descriptions of proper notation for diabetes diagnostic codes, which can be found in the tabular listing starting with 250. Diabetic diagnosis codes must be specified to the fifth digit, indicating the type of diabetes and whether it's under control. The fourth digit indicates the manifestation.

Sample of Ocular Manifestations Codes
362.0X  Diabetic retinopathy  
  Code first diabetes (250.5X)
365.41 Glaucoma associated with chamber angle anomalies
  Code first associated disorder as:
  Axenfeld's anomaly (743.33)
  Reiger's anomaly (743.55)
366.41 Diabetic cataract
  Code first diabetes (250.5X)

Rosacea conjunctivitis


 Code first underlying rosacea dermatitis (659.3)




Code first underlying condition (272.0-272.9)

Ocular manifestation

Once you determine the appropriate fourth and fifth digit for the diabetic code, refer to the additional instructions within the tabular listing to guide you to the appropriate secondary ocular manifestation code.

Remember the mandatory multiple coding rule when recording ocular manifestations of systemic disease. The primary diagnostic code refers to the disease process and the secondary diagnostic code designates the manifesting disease process. Use the most up-to-date ICD-9-CM book (version 2006) not only as a reference for specific ICD-9 diagnostic codes, but also for valuable information for accurate and efficient coding.

If you haven't ordered your 2006 ICD book yet, online resources such as are available to keep you current. OM


Optometric Management, Issue: December 2005