Type 1 diab with prolif diab rtnop with macular edema, bi

This code signifies Type 1 diabetes complicated by advanced diabetic retinopathy, specifically the proliferative stage, which is characterized by new, fragile blood vessel growth. Furthermore, the presence of macular edema, swelling in the central part of the retina responsible for sharp vision, is noted in both eyes. This combination indicates severe ocular involvement due to uncontrolled Type 1 diabetes.

Use this code when documentation clearly states a diagnosis of Type 1 diabetes and proliferative diabetic retinopathy with macular edema affecting both eyes. This typically applies to patients undergoing ophthalmologic evaluation or treatment for these specific diabetic complications. Supporting documentation should include ophthalmologist notes detailing the retinopathy stage and macular edema laterality.

• Ensure the documentation explicitly states "Type 1 diabetes" and "proliferative" retinopathy.
• Verify that macular edema is present and documented as "bilateral" to support the specificity of this code.
• Do not use this code if the macular edema is unilateral or if the retinopathy is nonproliferative.