ICD Code E11.319

ICD code E11.319 is used to classify a diagnosis of Type 2 diabetes mellitus in a patient who has developed diabetic retinopathy, a complication affecting the eyes, but without the presence of macular edema, which is a swelling in the central part of the retina. This code helps healthcare providers document and communicate the specific condition of the patient for treatment and billing purposes.

1. Diagnosis of Type 2 Diabetes Mellitus: Confirm the patient has been diagnosed with Type 2 diabetes mellitus, characterized by insulin resistance and often associated with obesity and a sedentary lifestyle.

2. Presence of Diabetic Retinopathy: Identify the presence of diabetic retinopathy, which involves damage to the blood vessels in the retina due to prolonged high blood sugar levels. This condition may be detected through a comprehensive eye examination.

3. Unspecified Severity of Retinopathy: Note that the severity or specific stage of diabetic retinopathy is not detailed. This could include early signs such as microaneurysms or more advanced symptoms like hemorrhages, but without specifying the exact stage.

4. Absence of Macular Edema: Confirm that there is no macular edema present. Macular edema involves swelling or thickening of the macula, the central area of the retina, which can lead to vision impairment. The absence of this condition should be documented.

5. Ongoing Monitoring and Management: Ensure that the patient is under regular monitoring for changes in their condition, as diabetic retinopathy can progress over time, potentially leading to more severe complications if not managed appropriately.

6. Documentation of Symptoms: Record any symptoms the patient may be experiencing related to diabetic retinopathy, such as blurred vision, floaters, or difficulty seeing at night, even if these symptoms are not directly linked to macular edema.

By following these criteria, healthcare providers can accurately use the ICD code to document and manage the patient's condition effectively within the healthcare revenue cycle.

For the ICD code E11.319, the relevant CPT codes that may be applicable include:

1. 92227 - Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral.

2. 92228 - Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation, and report, unilateral or bilateral.

3. 92002 - Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient.

4. 92004 - Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits.

5. 92012 - Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient.

6. 92014 - Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits.

7. 67028 - Intravitreal injection of a pharmacologic agent (separate procedure).

8. 67210 - Destruction of localized lesion of retina (e.g., macular edema, tumors), one or more sessions; photocoagulation.

These CPT codes are examples of procedures and services that may be relevant for managing and treating conditions associated with the ICD code E11.319. It is important for healthcare providers to select the appropriate CPT codes based on the specific services rendered and the clinical context.

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