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ICD-10 Guide
ICD-10 CodesE09.3511

E09.3511

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema (right eye)

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

Code Description

ICD-10 E09.3511 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema (right eye).

Key Diagnostic Point:

E09.3511 refers to diabetes mellitus that has been induced by drugs or chemicals, leading to significant complications such as proliferative diabetic retinopathy and macular edema specifically in the right eye. This condition arises when certain medications, such as corticosteroids or antipsychotics, disrupt normal glucose metabolism, resulting in hyperglycemia and subsequent diabetes. Proliferative diabetic retinopathy is characterized by the growth of new blood vessels in the retina, which can lead to vision loss. Macular edema, a common complication, occurs when fluid accumulates in the macula, the central part of the retina responsible for sharp vision. Patients may present with symptoms such as blurred vision or difficulty seeing colors. Management typically involves controlling blood glucose levels, monitoring HbA1c levels, and possibly using laser therapy or anti-VEGF injections to address retinal complications. Regular eye examinations are crucial for early detection and treatment of these complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of drug-induced diabetes mechanisms
  • Involves multiple complications (retinopathy and macular edema)
  • Specificity of eye involvement (right eye)
  • Need for accurate documentation of drug history

Audit Risk Factors

  • Inadequate documentation of drug history
  • Failure to specify eye involvement
  • Misclassification of diabetes type
  • Lack of evidence for complications

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed medication history, HbA1c levels, and management plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of the drug responsible for diabetes and its management.

Ophthalmology

Documentation Requirements

Detailed eye examination findings, including retinal imaging results.

Common Clinical Scenarios

Patients with diabetic retinopathy requiring treatment and follow-up.

Billing Considerations

Document specific findings related to macular edema and treatment interventions.

Coding Guidelines

Inclusion Criteria

Use E09.3511 When
  • Follow official ICD
  • 10 guidelines for coding diabetes, ensuring to document the cause (drug
  • induced) and the specific complications
  • Include HbA1c levels and treatment plans in the medical record to support coding

Exclusion Criteria

Do NOT use E09.3511 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document indication for laser treatment and prior retinal findings.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinal status pre- and post-procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of diabetes types and complications, improving the accuracy of claims and enhancing patient care through better data tracking.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of diabetes types and complications, improving the accuracy of claims and enhancing patient care through better data tracking.

Reimbursement & Billing Impact

The transition to ICD-10 allows for more specific coding of diabetes types and complications, improving the accuracy of claims and enhancing patient care through better data tracking.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of specifying the eye involved in E09.3511?

Specifying the eye involved is crucial for treatment planning and monitoring, as it affects the management of diabetic retinopathy and potential interventions.