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ICD-10 Guide
ICD-10 CodesE09.3531

E09.3531

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (right eye)

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

Code Description

ICD-10 E09.3531 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (right eye).

Key Diagnostic Point:

E09.3531 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 in the right eye. Proliferative diabetic retinopathy is characterized by the growth of new blood vessels on the retina, which can lead to severe vision impairment. The traction retinal detachment occurs when these new vessels pull on the retina, causing it to detach from the underlying tissue. This specific code indicates that the detachment does not involve the macula, which is crucial for central vision. Management of this condition often requires a multidisciplinary approach, including endocrinologists for diabetes management and ophthalmologists for retinal issues. Regular monitoring of HbA1c levels is essential to assess long-term glucose control, with targets typically set below 7% for most adults. Insulin therapy may be necessary, especially in cases where oral hypoglycemics are ineffective due to the drug-induced nature of the diabetes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of drug or chemical causing diabetes must be documented.
  • Detailed documentation of retinal complications is required.
  • Differentiation between types of diabetic retinopathy is necessary.
  • Management plans must be clearly outlined to justify the complexity.

Audit Risk Factors

  • Inadequate documentation of the drug or chemical causing diabetes.
  • Failure to document the severity of retinopathy.
  • Lack of clear treatment plans for diabetes management.
  • Insufficient follow-up documentation regarding retinal health.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Comprehensive records of diabetes management, including medication lists and HbA1c levels.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the cause of diabetes is clearly linked to the drug or chemical.

Ophthalmology

Documentation Requirements

Detailed retinal examination reports, imaging studies, and treatment plans for retinopathy.

Common Clinical Scenarios

Patients with proliferative diabetic retinopathy requiring laser treatment or vitrectomy.

Billing Considerations

Document the extent of retinal detachment and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E09.3531 When
  • According to ICD
  • 10 guidelines, E09 codes are used for diabetes mellitus secondary to other conditions, specifically drug or chemical
  • induced
  • Documentation must specify the drug or chemical, and the complications must be clearly outlined

Exclusion Criteria

Do NOT use E09.3531 When
  • Exclusions include diabetes not caused by drugs or chemicals

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Laser photocoagulation

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of retinopathy and treatment rationale.

Specialty Considerations

Ophthalmologists must provide detailed reports of the procedure.

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 conditions, improving the accuracy of claims and facilitating better patient management. E09.3531 provides a clear framework for documenting drug-induced diabetes and its complications, which was less specific in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related conditions, improving the accuracy of claims and facilitating better patient management. E09.3531 provides a clear framework for documenting drug-induced diabetes and its complications, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What types of drugs can induce diabetes mellitus?

Several classes of medications can induce diabetes, including corticosteroids, certain antipsychotics, and some antiretroviral drugs. It is essential to document the specific drug responsible for accurate coding.