Type 2 diab with prolif diab rtnop with macular edema, bi

This code describes a patient diagnosed with type 2 diabetes mellitus who has developed proliferative diabetic retinopathy, a severe form of diabetic eye disease characterized by new, abnormal blood vessel growth. Importantly, this code specifies the presence of macular edema, swelling in the central part of the retina, affecting both eyes.

Use this code when documentation clearly indicates type 2 diabetes and bilateral proliferative diabetic retinopathy with associated macular edema. This diagnosis is typically made by an ophthalmologist following a dilated eye exam, optical coherence tomography (OCT), and/or fluorescein angiography. Documentation should explicitly state "proliferative" retinopathy and "macular edema" affecting "both eyes."

• Ensure documentation specifies "proliferative" retinopathy; do not use for nonproliferative forms.
• Verify the presence of "macular edema" and laterality ("bilateral") as these are specific to this code.
• Always sequence the diabetes code (E11.-) first, followed by any associated complications.