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ICD-10 Guide
ICD-10 CodesE10.3393

E10.3393

Billable

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema (bilateral)

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

Code Description

ICD-10 E10.3393 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema (bilateral).

Key Diagnostic Point:

E10.3393 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by moderate nonproliferative diabetic retinopathy (NPDR) affecting both eyes, without the presence of macular edema. 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 chronic hyperglycemia. Moderate NPDR is identified by the presence of microaneurysms, retinal hemorrhages, and exudates, but without the more severe complications associated with proliferative diabetic retinopathy or macular edema. The absence of macular edema indicates that the central vision is less likely to be affected at this stage. Regular monitoring of HbA1c levels is crucial in managing diabetes and preventing complications, with targets typically set below 7% for most adults. Insulin management is essential for maintaining glycemic control, and patients may require adjustments in their insulin regimen based on their blood glucose levels and lifestyle factors.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the condition (Type 1 diabetes with retinopathy)
  • Differentiation between types of diabetic retinopathy
  • Requirement for bilateral specification
  • Need for accurate documentation of absence of macular edema

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to specify bilateral involvement
  • Misclassification of diabetic retinopathy type
  • Lack of HbA1c level documentation

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 diabetes complications and management strategies.

Ophthalmology

Documentation Requirements

Detailed eye examination findings, including retinal imaging results.

Common Clinical Scenarios

Routine eye exams for diabetic patients to monitor for retinopathy.

Billing Considerations

Accurate reporting of retinopathy severity and absence of macular edema is critical.

Coding Guidelines

Inclusion Criteria

Use E10.3393 When
  • According to ICD
  • 10 guidelines, E10
  • 3393 should be used when documenting Type 1 diabetes with moderate NPDR without macular edema
  • Coders must ensure that the documentation supports the diagnosis, including the absence of macular edema and the bilateral nature of the retinopathy

Exclusion Criteria

Do NOT use E10.3393 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 of retinopathy and any treatment recommendations.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinopathy severity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes care.

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 'bilateral' in this code?

Specifying 'bilateral' indicates that both eyes are affected by moderate NPDR, which is crucial for accurate diagnosis and treatment planning.

How often should patients with this diagnosis have their HbA1c levels checked?

Patients should have their HbA1c levels checked at least twice a year, or more frequently if their levels are above target or if there are changes in their treatment plan.