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ICD-10 Guide
ICD-10 CodesE10.3

E10.3

Billable

Type 1 diabetes mellitus with ophthalmic complications

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

Code Description

ICD-10 E10.3 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with ophthalmic complications.

Key Diagnostic Point:

Type 1 diabetes mellitus is a chronic condition characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. Patients with type 1 diabetes are at risk for various complications, including ophthalmic issues such as diabetic retinopathy, cataracts, and glaucoma. Diabetic retinopathy is the most common eye complication, resulting from damage to the blood vessels in the retina due to prolonged hyperglycemia. The risk of developing these complications increases with poor glycemic control, often measured by HbA1c levels. An HbA1c level above 7% indicates inadequate control and heightens the risk for complications. Insulin management is crucial for maintaining blood glucose levels within target ranges, and patients may require multiple daily injections or continuous subcutaneous insulin infusion. Regular eye examinations are essential for early detection and management of ophthalmic complications, which can lead to vision loss if left untreated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise documentation of ophthalmic complications
  • Differentiation between type 1 and type 2 diabetes
  • Understanding of diabetes management and HbA1c levels
  • Knowledge of related diabetic complications

Audit Risk Factors

  • Inadequate documentation of ophthalmic complications
  • Failure to document HbA1c levels
  • Incorrect coding of diabetes type
  • Lack of follow-up documentation for eye examinations

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of diabetes management, including insulin regimens and HbA1c levels.

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes and associated complications.

Billing Considerations

Ensure documentation reflects the type of diabetes and any complications accurately.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports detailing findings related to diabetic retinopathy or other complications.

Common Clinical Scenarios

Patients with diabetes presenting for routine eye exams or with vision changes.

Billing Considerations

Document the severity of retinopathy and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use E10.3 When
  • According to ICD
  • 10 guidelines, E10
  • 3 should be used when there is clear documentation of ophthalmic complications related to type 1 diabetes
  • It is important to include the specific type of ophthalmic complication in the documentation to support the use of this code

Exclusion Criteria

Do NOT use E10.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used during routine eye exams for diabetic patients.

Documentation Requirements

Document findings of the eye examination and any complications noted.

Specialty Considerations

Ophthalmologists should ensure that the examination details are comprehensive to support the diagnosis.

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 data collection and reimbursement processes. E10.3 provides a clear distinction for type 1 diabetes with ophthalmic complications, enhancing clinical understanding and 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 data collection and reimbursement processes. E10.3 provides a clear distinction for type 1 diabetes with ophthalmic complications, enhancing clinical understanding and management.

Reimbursement & Billing Impact

reimbursement processes. E10.3 provides a clear distinction for type 1 diabetes with ophthalmic complications, enhancing clinical understanding and management.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What are the common ophthalmic complications associated with type 1 diabetes?

Common ophthalmic complications include diabetic retinopathy, cataracts, and glaucoma. Regular eye examinations are crucial for early detection and management.