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ICD-10 Guide
ICD-10 CodesE10.319

E10.319

Billable

Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

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

Code Description

ICD-10 E10.319 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema.

Key Diagnostic Point:

E10.319 refers to Type 1 diabetes mellitus characterized by the presence of diabetic retinopathy, a common complication of diabetes that affects the eyes. This specific code indicates that the retinopathy is unspecified and does not involve macular edema, which is a more severe form of retinal damage. Diabetic retinopathy occurs due to damage to the blood vessels in the retina, leading to vision impairment. Patients with Type 1 diabetes often have fluctuating blood glucose levels, which can contribute to the progression of retinopathy. Regular monitoring of HbA1c levels is crucial, as maintaining these levels below 7% can help reduce the risk of complications. Insulin management is essential for Type 1 diabetes, as patients rely on exogenous insulin to control their blood glucose levels. The absence of macular edema in this code suggests that while there is retinal damage, it is not yet at the stage where it significantly affects central vision. Early detection and management of diabetic retinopathy are vital to prevent further complications, including vision loss.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of diabetic retinopathy
  • Understanding the absence of macular edema
  • Monitoring and documenting HbA1c levels
  • Insulin management and its impact on retinopathy

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Misclassification of diabetic retinopathy type
  • Lack of follow-up notes on 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 fluctuating blood glucose levels and routine eye exams.

Billing Considerations

Ensure comprehensive documentation of diabetes management and retinopathy assessments.

Ophthalmology

Documentation Requirements

Thorough eye examination reports, including findings related to diabetic retinopathy.

Common Clinical Scenarios

Patients with diabetes undergoing routine eye screenings or presenting with vision changes.

Billing Considerations

Document the absence of macular edema and specify the type of retinopathy observed.

Coding Guidelines

Inclusion Criteria

Use E10.319 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's diabetes type, retinopathy status, and any related complications
  • Include HbA1c levels and insulin management details as necessary

Exclusion Criteria

Do NOT use E10.319 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 related to diabetic retinopathy and any changes in vision.

Specialty Considerations

Ophthalmologists should ensure detailed notes on retinopathy status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

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

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What does E10.319 indicate?

E10.319 indicates Type 1 diabetes mellitus with unspecified diabetic retinopathy that does not involve macular edema, highlighting the need for careful monitoring and management of the patient's condition.