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ICD-10 Guide
ICD-10 CodesE09.3522

E09.3522

Billable

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

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

Code Description

ICD-10 E09.3522 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 (left eye).

Key Diagnostic Point:

E09.3522 refers to diabetes mellitus that is induced by drugs or chemicals, leading to significant complications such as proliferative diabetic retinopathy (PDR) and traction retinal detachment affecting the macula of the left eye. Drug-induced diabetes can arise from various medications, including corticosteroids, antipsychotics, and certain chemotherapy agents. Proliferative diabetic retinopathy is characterized by the growth of new blood vessels on the retina, which can lead to severe vision impairment. The presence of traction retinal detachment indicates that these new vessels have caused pulling on the retina, particularly affecting the macula, which is crucial for central vision. Management of this condition often involves controlling blood glucose levels, monitoring HbA1c levels, and potentially surgical intervention for the retinal detachment. The complexity of this diagnosis lies in the multifactorial nature of diabetes management and the need for careful monitoring of both metabolic and ocular health.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple conditions to document (diabetes, retinopathy, retinal detachment)
  • Need for precise documentation of drug-induced etiology
  • Differentiation between types of diabetic retinopathy
  • Potential for multiple specialties involved in care (endocrinology, ophthalmology)

Audit Risk Factors

  • Inadequate documentation of drug-induced diabetes
  • Failure to specify the type of diabetic retinopathy
  • Lack of clarity on the involvement of the macula
  • Inconsistent HbA1c level documentation

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed medication history, HbA1c levels, and diabetes management plans.

Common Clinical Scenarios

Patients with diabetes requiring insulin management and monitoring for complications.

Billing Considerations

Ensure clear documentation of drug-induced nature and its impact on diabetes control.

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, imaging results, and treatment plans for retinopathy.

Common Clinical Scenarios

Patients presenting with vision changes due to diabetic retinopathy.

Billing Considerations

Document the extent of retinal detachment and any surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use E09.3522 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the drug or chemical responsible for diabetes
  • Include details on the severity of retinopathy and the specific eye affected
  • Ensure compliance with guidelines for coding complications of diabetes

Exclusion Criteria

Do NOT use E09.3522 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of laser treatment and follow-up care.

Specialty Considerations

Ophthalmology should ensure clear documentation of the procedure and its necessity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management.

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 E09.3522?

Specifying the eye affected is crucial for treatment planning and understanding the severity of the condition, as it impacts management strategies and potential surgical interventions.