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ICD-10 Guide
ICD-10 CodesE09.3533

E09.3533

Billable

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

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

Code Description

ICD-10 E09.3533 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 (bilateral).

Key Diagnostic Point:

E09.3533 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. PDR is characterized by the growth of new blood vessels on the retina, which can lead to severe vision impairment. In this case, the traction retinal detachment does not involve the macula, which is crucial for central vision. The condition is often associated with poor glycemic control, indicated by elevated HbA1c levels, and may require insulin management to stabilize blood glucose levels. The presence of bilateral traction retinal detachment complicates the clinical picture, necessitating careful monitoring and potential surgical intervention. This code highlights the importance of recognizing the underlying cause of diabetes, as well as the need for comprehensive management of diabetic complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of drug or chemical causing diabetes must be documented.
  • Differentiation between types of diabetic retinopathy is required.
  • Bilateral involvement must be clearly stated in documentation.
  • Management of insulin therapy and HbA1c levels must be tracked.

Audit Risk Factors

  • Inadequate documentation of drug or chemical exposure.
  • Failure to document the severity of retinopathy.
  • Lack of clarity on the bilateral nature of the condition.
  • Insufficient tracking of HbA1c levels and insulin management.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed history of diabetes management, including medications and HbA1c levels.

Common Clinical Scenarios

Patients with drug-induced diabetes requiring insulin therapy.

Billing Considerations

Ensure documentation reflects the cause of diabetes and its management.

Ophthalmology

Documentation Requirements

Comprehensive eye exam findings, including details on retinopathy and retinal detachment.

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 E09.3533 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the cause of diabetes is clearly documented
  • Include details about the type of retinopathy and the nature of the retinal detachment
  • Ensure that all relevant clinical information is captured to support the use of this specific code

Exclusion Criteria

Do NOT use E09.3533 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Panretinal photocoagulation

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of retinopathy and treatment plan.

Specialty Considerations

Ophthalmology must provide detailed findings to support 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 complications, improving the accuracy of claims and enhancing patient care through better tracking of conditions.

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 enhancing patient care through better tracking of conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and enhancing patient care through better tracking of conditions.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of the bilateral aspect of this code?

The bilateral aspect indicates that both eyes are affected by traction retinal detachment, which is critical for treatment planning and understanding the severity of the condition.