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ICD-10 Guide
ICD-10 CodesE10.3212

E10.3212

Billable

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

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

Code Description

ICD-10 E10.3212 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (left eye).

Key Diagnostic Point:

E10.3212 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 left 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 due to prolonged hyperglycemia. Mild nonproliferative diabetic retinopathy indicates early changes in the retina, such as microaneurysms and retinal hemorrhages, without the growth of new blood vessels. Macular edema, a consequence of fluid accumulation in the macula, can lead to vision impairment. The management of this condition often involves strict glycemic control, with HbA1c levels ideally maintained below 7% to prevent further retinal damage. Insulin therapy is typically required for Type 1 diabetes, and regular ophthalmologic evaluations are crucial for monitoring retinal health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes classification and complications.
  • Involves knowledge of specific eye conditions related to diabetes.
  • Documentation must specify the eye affected and the severity of retinopathy.
  • Differentiation from other types of diabetic retinopathy codes.

Audit Risk Factors

  • Inadequate documentation of retinopathy severity.
  • Failure to document the affected eye.
  • Missing HbA1c levels in patient records.
  • Inconsistent coding of diabetes types.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes or complications requiring insulin adjustments.

Billing Considerations

Ensure comprehensive documentation of diabetes management plans and complications.

Ophthalmology

Documentation Requirements

Thorough eye examination reports detailing findings of retinopathy and macular edema.

Common Clinical Scenarios

Routine diabetic eye exams and treatment for diabetic retinopathy.

Billing Considerations

Document specific findings related to the left eye and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.3212 When
  • According to ICD
  • 10 guidelines, E10
  • 3212 should be used when a patient with Type 1 diabetes has been diagnosed with mild nonproliferative diabetic retinopathy and macular edema in the left eye
  • Documentation must support the diagnosis and specify the eye affected

Exclusion Criteria

Do NOT use E10.3212 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

Complete eye examination findings and any interventions.

Specialty Considerations

Ophthalmologists should document specific findings related to diabetic retinopathy.

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 reimbursement processes. E10.3212 provides a clear distinction between types and severity of diabetic retinopathy, which is crucial for effective management and treatment planning.

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 reimbursement processes. E10.3212 provides a clear distinction between types and severity of diabetic retinopathy, which is crucial for effective management and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. E10.3212 provides a clear distinction between types and severity of diabetic retinopathy, which is crucial for effective management and treatment planning.

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 documenting the affected eye in E10.3212?

Documenting the affected eye is crucial for accurate coding and treatment planning, as it helps differentiate between unilateral and bilateral conditions, which can affect management strategies.

How often should patients with E10.3212 have their eyes examined?

Patients with Type 1 diabetes and diabetic retinopathy should have their eyes examined at least annually, or more frequently if retinopathy is present or if there are changes in vision.