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ICD-10 Guide
ICD-10 CodesE09.3491

E09.3491

Billable

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema (right eye)

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E09.3491 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema (right eye).

Key Diagnostic Point:

E09.3491 refers to diabetes mellitus that has been induced by drugs or chemicals, characterized by severe nonproliferative diabetic retinopathy affecting the right eye without the presence of macular edema. This condition arises when certain medications or toxic substances lead to insulin resistance or impaired insulin secretion, resulting in elevated blood glucose levels. The severe nonproliferative diabetic retinopathy indicates significant retinal damage, which can lead to vision impairment if not managed appropriately. The absence of macular edema suggests that while there is retinal damage, the central vision area remains unaffected. Management of this condition typically involves controlling blood glucose levels through insulin therapy or oral hypoglycemics, regular monitoring of HbA1c levels, and ophthalmologic evaluations to assess the progression of retinopathy. The interplay between diabetes management and the effects of the inducing agent is crucial for patient care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Identification of drug or chemical causing diabetes
  • Differentiation between types of diabetic retinopathy
  • Specificity required for eye involvement
  • Management of diabetes in the context of drug-induced conditions

Audit Risk Factors

  • Inadequate documentation of the inducing drug or chemical
  • Failure to specify the eye affected
  • Incorrect coding of retinopathy type
  • Lack of HbA1c monitoring records

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed history of diabetes onset, medication history, and HbA1c levels.

Common Clinical Scenarios

Patients presenting with new-onset diabetes due to medication, requiring insulin management.

Billing Considerations

Close monitoring of blood glucose levels and potential adjustments in therapy based on the inducing agent.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports, including retinal imaging and assessment of retinopathy severity.

Common Clinical Scenarios

Patients with diabetes presenting for routine eye exams or with vision changes.

Billing Considerations

Documentation must clearly state the absence of macular edema and the specific eye affected.

Coding Guidelines

Inclusion Criteria

Use E09.3491 When
  • According to ICD
  • 10 guidelines, E09 codes are used for diabetes mellitus due to drugs or chemicals
  • It is essential to document the specific drug or chemical causing the condition and the type of diabetic retinopathy present

Exclusion Criteria

Do NOT use E09.3491 When
  • Exclusions include diabetes not induced by drugs or chemicals

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for diabetes management.

Documentation Requirements

Document patient's diabetes management plan, including medications and HbA1c levels.

Specialty Considerations

Endocrinologists should ensure comprehensive documentation of diabetes control.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of drug-induced diabetes and its complications, improving the accuracy of patient records and facilitating better management of care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of drug-induced diabetes and its complications, improving the accuracy of patient records and facilitating better management of care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of drug-induced diabetes and its complications, improving the accuracy of patient records and facilitating better management of care.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of specifying the eye affected in E09.3491?

Specifying the eye affected is crucial for treatment planning and monitoring of diabetic retinopathy, as it can influence management strategies and patient outcomes.