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ICD-10 Guide
ICD-10 CodesE10.311

E10.311

Billable

Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema

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

Code Description

ICD-10 E10.311 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema.

Key Diagnostic Point:

E10.311 refers to Type 1 diabetes mellitus, a chronic condition characterized by the body's inability to produce insulin due to autoimmune destruction of pancreatic beta cells. This specific code indicates the presence of diabetic retinopathy, a common complication of diabetes that affects the eyes, leading to potential vision loss. The term 'unspecified' suggests that the exact type or stage of retinopathy has not been documented, while 'macular edema' indicates swelling in the macula, the central part of the retina responsible for sharp vision. Macular edema can lead to significant visual impairment and is often associated with prolonged hyperglycemia, which can be monitored through HbA1c levels. Management typically involves strict glycemic control, often requiring insulin therapy, and regular ophthalmologic evaluations to monitor for progression of retinopathy. The complexity of managing diabetes and its complications necessitates a multidisciplinary approach, including endocrinologists and ophthalmologists, to optimize patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for precise documentation of retinopathy type and severity
  • Management of multiple complications associated with diabetes
  • Variability in insulin management and dosing
  • Monitoring and documentation of HbA1c levels

Audit Risk Factors

  • Inadequate documentation of retinopathy type
  • Failure to document HbA1c levels
  • Lack of clarity on insulin management plans
  • Inconsistent coding of diabetic complications

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, requiring insulin adjustments.

Billing Considerations

Ensure comprehensive documentation of all diabetes-related complications.

Ophthalmology

Documentation Requirements

Detailed findings from eye examinations, including assessments of retinopathy and macular edema.

Common Clinical Scenarios

Patients with visual disturbances due to diabetic retinopathy.

Billing Considerations

Document the severity and treatment of retinopathy to support coding.

Coding Guidelines

Inclusion Criteria

Use E10.311 When
  • According to ICD
  • 10 coding guidelines, E10
  • 311 should be used when there is clear documentation of Type 1 diabetes with unspecified diabetic retinopathy and macular edema
  • It is essential to ensure that the documentation supports the diagnosis and that all relevant complications are noted

Exclusion Criteria

Do NOT use E10.311 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

Complete eye exam findings, including visual acuity and fundoscopic results.

Specialty Considerations

Ensure that the exam is documented as part of diabetes management.

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 patient records and facilitating better management of chronic 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 patient records and facilitating better management of chronic conditions.

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    American Diabetes Association
  • •
    American Academy of Ophthalmology

Coding & Billing References

  • •
    American Diabetes Association
  • •
    American Academy of Ophthalmology

Frequently Asked Questions

What is the significance of macular edema in diabetic retinopathy?

Macular edema is a critical complication of diabetic retinopathy that can lead to significant vision loss. It occurs due to fluid accumulation in the macula, affecting central vision. Early detection and management are essential to prevent irreversible damage.