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ICD-10 Guide
ICD-10 CodesE09.3521

E09.3521

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula (right eye)

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

Code Description

ICD-10 E09.3521 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula (right eye).

Key Diagnostic Point:

E09.3521 refers to diabetes mellitus that is induced by drugs or chemicals, which can lead to various complications, including proliferative diabetic retinopathy. This specific code indicates that the patient has developed traction retinal detachment involving the macula in the right eye due to the effects of diabetes. Proliferative diabetic retinopathy is characterized by the growth of new blood vessels in the retina, which can lead to severe vision impairment or loss. The presence of traction retinal detachment indicates that these new vessels have caused the retina to pull away from the underlying tissue, particularly affecting the macula, the area responsible for sharp central vision. Management of this condition often involves controlling blood glucose levels, monitoring HbA1c levels, and potentially surgical intervention to address the retinal detachment. Insulin management may be necessary to stabilize blood sugar levels, especially in cases where the diabetes is drug-induced.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition (drug-induced diabetes with complications)
  • Need for detailed documentation of retinopathy and retinal detachment
  • Differentiation from other types of diabetes and retinopathy
  • Potential for multiple comorbidities affecting coding

Audit Risk Factors

  • Inadequate documentation of drug or chemical exposure
  • Failure to document the severity of retinopathy
  • Lack of clarity on the involvement of the macula
  • Inconsistent HbA1c levels not correlating with diabetes management

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including imaging results and visual acuity assessments.

Common Clinical Scenarios

Patients presenting with vision changes due to diabetic retinopathy or retinal detachment.

Billing Considerations

Ensure documentation specifies the eye affected and the type of retinal detachment.

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including medication history and HbA1c levels.

Common Clinical Scenarios

Patients with drug-induced diabetes requiring insulin therapy and monitoring.

Billing Considerations

Document the specific drugs causing diabetes and their effects on blood glucose control.

Coding Guidelines

Inclusion Criteria

Use E09.3521 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the cause of diabetes and associated complications
  • Include details on the type of drug or chemical involved and the specific nature of the retinopathy and retinal detachment

Exclusion Criteria

Do NOT use E09.3521 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation

Clinical Scenario

Used for treating proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of retinopathy and treatment rationale.

Specialty Considerations

Ophthalmology should provide detailed notes on the procedure and patient response.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of conditions like drug-induced diabetes and its complications, improving the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of conditions like drug-induced diabetes and its complications, improving the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 allows for more specific coding of conditions like drug-induced diabetes and its complications, improving the accuracy of patient records and treatment plans.

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 affected in E09.3521?

Specifying the eye affected is crucial for treatment planning and understanding the severity of the condition, as it directly impacts the patient's vision and management strategies.