Retinal vasculitis, bilateral

This code represents inflammation of the blood vessels in the retina affecting both eyes. This condition can lead to vision impairment due to compromised blood flow and potential damage to retinal tissue. It encompasses various inflammatory processes, including those associated with systemic diseases or infectious etiologies.

Use this code when documentation clearly indicates bilateral retinal vasculitis. This diagnosis is typically supported by ophthalmological examination findings such as perivascular sheathing, hemorrhages, or exudates, often confirmed by fluorescein angiography. It is appropriate for both primary and secondary forms of retinal vasculitis.

• Always specify laterality if documented as unilateral (e.g., right or left eye) rather than using this bilateral code.
• Code any underlying systemic condition (e.g., lupus, sarcoidosis) or infectious agent (e.g., viral, bacterial) as a primary diagnosis when applicable, with retinal vasculitis as a secondary diagnosis.
• Ensure the physician's documentation explicitly states "bilateral" or indicates involvement of both eyes to support the use of this code.