ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesE10.3211

E10.3211

Billable

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (right eye)

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

Code Description

ICD-10 E10.3211 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (right eye).

Key Diagnostic Point:

E10.3211 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by mild nonproliferative diabetic retinopathy and macular edema in the right eye. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. Diabetic retinopathy is a common complication of diabetes, resulting from damage to the retinal blood vessels. In the case of mild nonproliferative diabetic retinopathy, there are early signs of retinal damage, such as microaneurysms and retinal hemorrhages, but no new blood vessel growth (proliferation). Macular edema indicates that fluid has accumulated in the macula, the central part of the retina responsible for sharp vision, leading to potential vision impairment. Management of this condition typically involves strict glycemic control, regular ophthalmologic examinations, and possibly the use of anti-VEGF (vascular endothelial growth factor) injections or laser therapy to address the macular edema.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the eye affected (right eye)
  • Differentiation between types of diabetic retinopathy
  • Need for detailed documentation of diabetes management
  • Potential for co-existing conditions

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to specify the eye affected
  • Lack of evidence for diabetes management plans
  • Inconsistent HbA1c levels reported

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of HbA1c levels, insulin regimen, and diabetes management plans.

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes, requiring insulin adjustments.

Billing Considerations

Ensure documentation reflects the complexity of diabetes management and any complications.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Routine diabetic eye exams and treatment for diabetic retinopathy.

Billing Considerations

Document the specific type of retinopathy and any treatments administered.

Coding Guidelines

Inclusion Criteria

Use E10.3211 When
  • According to ICD
  • 10 guidelines, E10
  • 3211 should be used when the patient has Type 1 diabetes with specified mild nonproliferative diabetic retinopathy and macular edema in the right eye
  • It is essential to document the severity of retinopathy and the specific eye affected

Exclusion Criteria

Do NOT use E10.3211 When
  • Exclusion criteria include cases where the retinopathy is classified as moderate or severe

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 diabetic retinopathy and any treatments provided.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinal findings.

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 facilitating better patient 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 claims and facilitating better patient management.

Reimbursement & Billing Impact

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

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 specifying the eye affected?

Specifying the eye affected is crucial for treatment planning and monitoring, as diabetic retinopathy can progress differently in each eye.

How often should patients with this diagnosis be monitored?

Patients should undergo regular eye examinations, typically annually, or more frequently if retinopathy is present or worsening.