Oth diab with prolif diab rtnop without macular edema, unsp

This code signifies a form of diabetes mellitus, not type 1 or type 2, that has led to the development of proliferative diabetic retinopathy. This specific stage of retinopathy involves new, abnormal blood vessel growth in the retina but does not include swelling of the macula. The affected eye is not specified.

Apply this code when documentation clearly indicates a diagnosis of "other specified diabetes mellitus" and the presence of proliferative diabetic retinopathy without macular edema. This is appropriate when the medical record does not specify which eye is affected (e.g., "bilateral" or "unspecified eye").

• Ensure the documentation specifies "other specified diabetes mellitus" and not type 1 or type 2.
• Verify the absence of macular edema; if present, a different code for retinopathy with macular edema would be appropriate.
• Only use this code when the affected eye is not documented; otherwise, use a more specific code for the right or left eye.