2017 ICD-10 Updates
In this document:
• Overview, 2
•
•
®
New ICD-10 Codes Effective October 1, 2016, 3

Proliferative Diabetic Retinopathy (Type 1), 4

Proliferative Diabetic Retinopathy (Type 2), 4

Proliferative Diabetic Retinopathy Other), 5

Nonproliferative Diabetic Retinopathy (Type 1), 6

Nonproliferative Diabetic Retinopathy (Type 2), 7

Nonproliferative Diabetic Retinopathy (Other), 7

Central Retinal Vein Occlusion, 8

Branch Retinal Vein Occlusion, 8

Age-Related Macular Degeneration (Dry), 9

Age-Related Macular Degeneration (Wet), 9

Primary Open-Angle Glaucoma, 10

Amblyopia, 10

Postprocedural Hemotoma, 10

Postprocedural Seroma, 11
ICD-10 Codes Retiring September 30, 2016, 11
2017 ICD-10 Updates
1
2017 ICD-10 Updates
Overview
Overview

Proliferative Diabetic Retinopathy, 11

Nonproliferative Diabetic Retinopathy (Type 1), 12

Nonproliferative Diabetic Retinopathy (Type 2), 13

Nonproliferative Diabetic Retinopathy (Other), 13

Nonproliferative Diabetic Retinopathy (Due to Underlying Condition), 14

Nonproliferative Diabetic Retinopathy (Drug or Chemical Induced), 15

Retinal Vein Occlusion, 15

Age-Related Macular Degeneration, 16

Primary Open-Angle Glaucoma, 16
CMS is making minor changes to the ICD-10-CM code set, Although these changes are referred to as the “2017” ICD-10
update, they are effective October 1, 2016. In some cases, CMS added new codes and retired others. In other cases, only
the description associated with the code changed.
Eyefinity software and platforms are prepared to ease your transition to the new codes.
October 1 is the so-called “cutover date.” The updated codes apply only to claims with a service date of October 1 or later.
Claims with a service date of September 30 or earlier will continue to use the 2016 codes. Billers should familiarize
themselves with the changes. Billers should be prepared to verify that the correct codes are appearing on claims
Eyefinity has identified over 400 ICD-10 changes that apply to eyecare. Code changes to the following areas take effect
on October 1, 2016:
2
•
Diabetic retinopathy
•
Retinal vein occlusion
•
Age-related macular degeneration
•
Primary open-angle glaucoma
•
Amblyopia
•
Postprocedural hematoma or seroma
2017 ICD-10 Updates
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
We anticipate that CMS will modify ICD-10 codes slightly, effective October 1, every year.
Additionally, CMS is ending the flexibility it allowed during the first year of ICD-10 coding whereby CMS accepted more
general sign/symptom and “unspecified” codes. “Unspecified” codes are still valid, but their use should be limited. CMS
expects you to code exams to the best level of certainty known for each encounter. This means you’ll be required to code
to the fourth, fifth, sixth, and seventh digit when exam findings require.
New ICD-10
Codes Effective October
1, 2016
This section lists the new eyecare-related ICD-10 codes that are effective October 1, 2016. Many of the codes apply to rare
conditions, but are provided here for reference.
•
Proliferative Diabetic Retinopathy (Type 1), 4
•
Proliferative Diabetic Retinopathy (Type 2), 4
•
Proliferative Diabetic Retinopathy Other), 5
•
Nonproliferative Diabetic Retinopathy (Type 1), 6
•
Nonproliferative Diabetic Retinopathy (Type 2), 7
•
Nonproliferative Diabetic Retinopathy (Other), 7
•
Central Retinal Vein Occlusion, 8
•
Branch Retinal Vein Occlusion, 8
•
Age-Related Macular Degeneration (Dry), 9
•
Age-Related Macular Degeneration (Wet), 9
•
Primary Open-Angle Glaucoma, 10
•
Amblyopia, 10
•
Postprocedural Hemotoma, 10
•
Postprocedural Seroma, 11
2017 ICD-10 Updates
3
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Proliferative Diabetic Retinopathy (Type 1)
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
With macular edema and diabetes type 1
E10.3511
E10.3512
E10.3513
E10.3519
Without macular edema and diabetes type 1
E10.3591
E10.3592
E10.3593
E10.3599
With traction retinal detachment involving macula
type 1
E10.3521
E10.3522
E10.3523
E10.3529
With traction retinal detachment not involving
macula type 1
E10.3531
E10.3532
E10.3533
E10.3539
With combined traction retinal detachment and
rhegmatogenous retinal detachment type 1
E10.3541
E10.3542
E10.3543
E10.3549
With stable proliferative diabetic retinopathy
type 1
E10.3551
E10.3552
E10.3553
E10.3559
With macular edema resolved following treatment
type 1
E10.37X1
E10.37X2
E10.37X3
E10.37X9
Proliferative Diabetic Retinopathy (Type 2)
The following codes are effective beginning October 1, 2016.
4
Description
Right Eye
Left Eye
Bilateral
Unspecified
With macular edema and diabetes type 2
E11.3511
E11.3512
E11.3513
E11.3519
Without macular edema and diabetes type 2
E11.3591
E11.3592
E11.3593
E11.3599
2017 ICD-10 Updates
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Description
Right Eye
Left Eye
Bilateral
Unspecified
With traction retinal detachment involving macula
type 2
E11.3521
E11.3522
E11.3523
E11.3529
With traction retinal detachment not involving
macula type 2
E11.3531
E11.3532
E11.3533
E11.3539
With combined traction retinal detachment and
rhegmatogenous retinal detachment type 2
E11.3541
E11.3542
E11.3543
E11.3549
With stable proliferative diabetic retinopathy
type 2
E11.3551
E11.3552
E11.3553
E11.3559
With macular edema resolved following treatment
type 2
E11.37X1
E11.37X2
E11.37X3
E11.37X9
Left Eye
Bilateral
Unspecified
With macular edema and other specified diabetes E13.3511
E13.3512
E13.3513
E13.3519
Without macular edema and other specified
diabetes
E13.3591
E13.3592
E13.3593
E13.3599
With traction retinal detachment involving macula
and other specified diabetes
E13.3521
E13.3522
E13.3523
E13.3529
With traction retinal detachment not involving
macula and other specified diabetes
E13.3531
E13.3532
E13.3533
E13.3539
Proliferative Diabetic Retinopathy Other)
The following codes are effective beginning October 1, 2016.
Description
2017 ICD-10 Updates
Right Eye
5
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Description
Right Eye
Left Eye
Bilateral
Unspecified
With combined traction retinal detachment and
rhegmatogenous retinal detachment and other
specified diabetes
E13.3541
E13.3542
E13.3543
E13.3549
With stable proliferative diabetic retinopathy and
other specified diabetes
E13.3551
E13.3552
E13.3553
E13.3559
With macular edema resolved following treatment
and other specified diabetes
E13.37X1
E13.37X2
E13.37X3
E13.37X9
Nonproliferative Diabetic Retinopathy (Type 1)
The following codes are effective beginning October 1, 2016.
6
Description
Right Eye
Left Eye
Bilateral
Unspecified
Mild with macular edema and diabetes type 1
E10.3211
E10.3212
E10.3213
E10.3219
Mild without macular edema and diabetes type 1
E10.3291
E10.3292
E10.3293
E10.3299
Moderate with macular edema and diabetes
type 1
E10.3311
E10.3312
E10.3313
E10.3319
Moderate without macular edema and diabetes
type 1
E10.3391
E10.3392
E10.3393
E10.3399
Severe with macular edema and diabetes type 1
E10.3411
E10.3412
E10.3413
E10.3419
Severe without macular edema and diabetes
type 1
E10.3491
E10.3492
E10.3493
E10.3499
2017 ICD-10 Updates
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Nonproliferative Diabetic Retinopathy (Type 2)
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Mild with macular edema and diabetes type 2
E11.3211
E11.3212
E11.3213
E11.3219
Mild without macular edema and diabetes type 2
E11.3291
E11.3292
E11.3293
E11.3299
Moderate with macular edema and diabetes
type 2
E11.3311
E11.3312
E11.3313
E11.3319
Moderate without macular edema and diabetes
type 2
E11.3391
E11.3392
E11.3393
E11.3399
Severe with macular edema and diabetes type 2
E11.3411
E11.3412
E11.3413
E11.3419
Severe without macular edema and diabetes
type 2
E11.3491
E11.3492
E11.3493
E11.3499
Nonproliferative Diabetic Retinopathy (Other)
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Mild with macular edema and other specified
diabetes
E13.3211
E13.3212
E13.3213
E13.3219
Mild without macular edema and other specified
diabetes
E13.3291
E13.3292
E13.3293
E13.3299
Moderate with macular edema and other
specified diabetes
E13.3311
E13.3312
E13.3313
E13.3319
2017 ICD-10 Updates
7
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Description
Right Eye
Left Eye
Bilateral
Unspecified
Moderate without macular edema and other
specified diabetes
E13.3391
E13.3392
E13.3393
E13.3399
Severe with macular edema and other specified
diabetes
E13.3411
E13.3412
E13.3413
E13.3419
Severe without macular edema and other
specified diabetes
E13.3491
E13.3492
E13.3493
E13.3499
Central Retinal Vein Occlusion
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
With macular edema
H34.8110
H34.8120
H34.8130
H34.8190
With retinal neovascularization
H34.8111
H34.8121
H34.8131
H34.8191
Stable
H34.8112
H34.8122
H34.8132
H34.8192
Branch Retinal Vein Occlusion
The following codes are effective beginning October 1, 2016.
8
Description
Right Eye
Left Eye
Bilateral
Unspecified
With macular edema
H34.8310
H34.8320
H34.8330
H34.8390
With retinal neovascularization
H34.8311
H34.8321
H34.8331
H34.8391
Stable
H34.8312
H34.8322
H34.8332
H34.8392
2017 ICD-10 Updates
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Age-Related Macular Degeneration (Dry)
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Stage unspecified
H35.3110
H35.3120
H35.3130
H35.3190
Early dry stage
H35.3111
H35.3121
H35.3131
H35.3191
Intermediate dry stage
H35.3112
H35.3122
H35.3132
H35.3192
Advanced atrophic without suboveal involvement H35.3113
H35.3123
H35.3133
H35.3193
Advanced atrophic with suboveal involvement
H35.3124
H35.3134
H35.3194
H35.3114
Age-Related Macular Degeneration (Wet)
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Stage unspecified
H35.3210
H35.3220
H35.3230
H35.3290
With active choroidal neovascularization
H35.3211
H35.3221
H35.3231
H35.3291
With inactive choroidal neovascularization with
involuted or regressed neovascularization
H35.3212
H35.3222
H35.3232
H35.3292
With inactive scar
H35.3213
H35.3223
H35.3233
H35.3293
2017 ICD-10 Updates
9
2017 ICD-10 Updates
New ICD-10 Codes Effective October 1, 2016
Primary Open-Angle Glaucoma
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Stage unspecified
H40.1110
H40.1120
H40.1130
H40.1190
Mild stage
H40.1111
H40.1121
H40.1131
H40.1191
Moderate stage
H40.1112
H40.1122
H40.1132
H40.1192
Severe Stage
H40.1113
H40.1123
H40.1133
H40.1193
Indeterminate stage
H40.1114
H40.1124
H40.1134
H40.1194
Amblyopia
The following codes are effective beginning October 1, 2016.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Amblyopia suspect
H53.041
H53.042
H53.043
H53.049
Postprocedural Hemotoma
The following codes are effective beginning October 1, 2016.
10
Description
Right Eye
Left Eye
Bilateral
Unspecified
And adnexa following an ophthalmic procedure
H59.331
H59.332
H59.333
H59.339
And adnexa following an other procedure
H59.341
H59.342
H59.343
H59.349
2017 ICD-10 Updates
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Postprocedural Seroma
The following codes are effective beginning October 1, 2016.
ICD-10 Codes
Retiring
September
30, 2016
Description
Right Eye
Left Eye
Bilateral
Unspecified
And adnexa following an ophthalmic procedure
H59.351
H59.352
H59.353
H59.359
And adnexa following an other procedure
H59.361
H59.362
H59.363
H59.369
This section lists the eyecare-related ICD-10 codes that will no longer be accepted for services after September 30, 2016.
•
Proliferative Diabetic Retinopathy, 11
•
Nonproliferative Diabetic Retinopathy (Type 1), 12
•
Nonproliferative Diabetic Retinopathy (Type 2), 13
•
Nonproliferative Diabetic Retinopathy (Other), 13
•
Nonproliferative Diabetic Retinopathy (Due to Underlying Condition), 14
•
Nonproliferative Diabetic Retinopathy (Drug or Chemical Induced), 15
•
Retinal Vein Occlusion, 15
•
Age-Related Macular Degeneration, 16
•
Primary Open-Angle Glaucoma, 16
Proliferative Diabetic Retinopathy
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
Description
Unspecified
With macular edema
E08.351
Without macular edema
E08.359
2017 ICD-10 Updates
11
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Description
Unspecified
Drug or chemical induced with macular edema
E09.351
Drug or chemical induced without macular edema E09.359
With macular edema and diabetes type 1
E10.351
Without macular edema and diabetes type 1
E10.359
With macular edema and diabetes type 2
E11.351
Without macular edema and diabetes type 2
E11.359
With macular edema and other specified diabetes E13.351
Without macular edema and other specified
diabetes
E13.359
Nonproliferative Diabetic Retinopathy (Type 1)
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
12
Description
Unspecified
Mild with macular edema and diabetes type 1
E10.321
Mild without macular edema and diabetes type 1
E10.329
Moderate with macular edema and diabetes type
1
E10.331
Moderate without macular edema and diabetes
type 1
E10.339
Severe with macular edema and diabetes type 1
E10.341
2017 ICD-10 Updates
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Description
Unspecified
Severe without macular edema and diabetes type
1
E10.349
Nonproliferative Diabetic Retinopathy (Type 2)
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
Description
Unspecified
Mild with macular edema and diabetes type 2
E11.321
Mild without macular edema and diabetes type 2
E11.329
Moderate with macular edema and diabetes type
2
E11.331
Moderate without macular edema and diabetes
type 2
E11.339
Severe with macular edema and diabetes type 2
E11.341
Severe without macular edema and diabetes type
2
E11.349
Nonproliferative Diabetic Retinopathy (Other)
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
Description
Unspecified
Mild with macular edema and other specified
diabetes
E13.321
2017 ICD-10 Updates
13
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Description
Unspecified
Mild without macular edema and other specified
diabetes
E13.329
Moderate with macular edema and other
specified diabetes
E13.331
Moderate without macular edema and other
specified diabetes
E13.339
Severe with macular edema and other specified
diabetes
E13.341
Severe without macular edema and other
specified diabetes
E13.349
Nonproliferative Diabetic Retinopathy (Due to Underlying Condition)
The following codes are being retired after September 30, 2016.
14
Description
Unspecified
Mild with macular edema
E08.321
Mild without macular edema
E08.329
Moderate with macular edema
E08.331
Moderate without macular edema
E08.339
Severe with macular edema
E08.341
Severe without macular edema
E08.349
2017 ICD-10 Updates
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Nonproliferative Diabetic Retinopathy (Drug or Chemical Induced)
The following codes are being retired after September 30, 2016.
Description
Unspecified
Mild with macular edema
E09.321
Mild without macular edema
E09.329
Moderate with macular edema
E09.331
Moderate without macular edema
E09.339
Severe with macular edema
E09.341
Severe without macular edema
E09.349
Retinal Vein Occlusion
The following codes are being retired after September 30, 2016. The new codes add a digit in the sixth position to further
specify the condition.
Description
Right Eye
Left Eye
Bilateral
Unspecified
Central
H34.811
H34.812
H34.813
H34.819
Tributary (branch)
H34.831
H34.832
H34.833
H34.839
2017 ICD-10 Updates
15
2017 ICD-10 Updates
ICD-10 Codes Retiring September 30, 2016
Age-Related Macular Degeneration
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
Additional codes further specify the ARMD condition.
Description
Unspecified
Nonexudative
H35.31
Exudative
H35.32
Primary Open-Angle Glaucoma
The following codes are being retired after September 30, 2016. The new codes add a digit to the end to specify laterality.
16
Description
Unspecified
Stage unspecified
H40.11X0
Mild stage
H40.11X1
Moderate stage
H40.11X2
Severe Stage
H40.11X3
Indeterminate stage
H40.11X4
2017 ICD-10 Updates