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ICD-10 Guide
ICD-10 CodesE10.3219

E10.3219

Billable

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

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

Code Description

ICD-10 E10.3219 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (unspecified eye).

Key Diagnostic Point:

E10.3219 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by mild nonproliferative diabetic retinopathy and macular edema in an unspecified 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 is the early stage of this condition, where small areas of swelling (microaneurysms) occur in the retina, and macular edema indicates fluid accumulation in the macula, the central part of the retina responsible for sharp vision. This condition can lead to vision impairment if not managed properly. Regular monitoring of HbA1c levels is crucial, as maintaining them below 7% can help prevent or slow the progression of diabetic retinopathy. Insulin management is essential for controlling blood glucose levels, and patients may require adjustments in their insulin regimen based on their blood sugar readings and overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Need for accurate documentation of retinopathy severity
  • Differentiation between types of diabetic retinopathy
  • Management of insulin therapy and its impact on retinopathy

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of clarity on insulin management
  • Misclassification of eye involvement

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 documentation reflects the relationship between diabetes control and retinopathy progression.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Patients undergoing routine eye exams for diabetes-related eye complications.

Billing Considerations

Document the specific type and severity of retinopathy and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use E10.3219 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the type of diabetes, the presence of retinopathy, and any associated complications
  • Include HbA1c levels and treatment details to support the diagnosis

Exclusion Criteria

Do NOT use E10.3219 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 retinopathy assessment.

Documentation Requirements

Document findings of the eye exam, including retinopathy severity.

Specialty Considerations

Ophthalmologists should ensure detailed notes on retinopathy stages.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of diabetes-related complications, improving the accuracy of patient records and reimbursement processes. E10.3219 provides a clear indication of the severity of retinopathy, which is crucial for treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of diabetes-related complications, improving the accuracy of patient records and reimbursement processes. E10.3219 provides a clear indication of the severity of retinopathy, which is crucial for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. E10.3219 provides a clear indication of the severity of retinopathy, which is crucial for 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 coding E10.3219?

Coding E10.3219 accurately reflects the patient's condition of Type 1 diabetes with mild nonproliferative diabetic retinopathy and macular edema, which is essential for appropriate management and treatment planning.

How often should HbA1c levels be monitored in patients with E10.3219?

Patients with E10.3219 should have their HbA1c levels monitored at least every three to six months, depending on their diabetes management and control.