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)

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.

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

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

Proliferative Diabetic Retinopathy Other)

The following codes are effective beginning October 1, 2016.

Description Right Eye 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

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.

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

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

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.

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

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

H35.3114

H35.3124

H35.3134

H35.3194

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

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.

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

Postprocedural Seroma

The following codes are effective beginning October 1, 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