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ICD-10 Guide
ICD-10 CodesE10.3399

E10.3399

Billable

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

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

Code Description

ICD-10 E10.3399 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema (unspecified eye).

Key Diagnostic Point:

E10.3399 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by moderate nonproliferative diabetic retinopathy (NPDR) without 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. Moderate NPDR is identified by the presence of microaneurysms, retinal hemorrhages, and exudates, but without the presence of macular edema, which is a more severe form of retinopathy. Management of this condition typically involves strict glycemic control, regular eye examinations, and possibly insulin therapy to maintain HbA1c levels within target ranges. The absence of macular edema indicates a better prognosis compared to proliferative diabetic retinopathy, but ongoing monitoring is essential to prevent progression.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of diabetic retinopathy
  • Understanding the nuances of diabetic complications
  • Accurate documentation of eye conditions
  • Management of HbA1c levels and insulin therapy

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Misclassification of diabetic retinopathy type
  • Lack of follow-up 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 and complications such as retinopathy.

Billing Considerations

Ensure comprehensive documentation of diabetes management and complications.

Ophthalmology

Documentation Requirements

Detailed eye examination findings, including retinal imaging results.

Common Clinical Scenarios

Patients undergoing routine eye exams for diabetic retinopathy screening.

Billing Considerations

Document the absence of macular edema and the specific findings of NPDR.

Coding Guidelines

Inclusion Criteria

Use E10.3399 When
  • According to ICD
  • 10 guidelines, E10
  • 3399 should be used when the patient has Type 1 diabetes with moderate NPDR without macular edema
  • Coders must ensure that documentation supports the diagnosis and that the absence of macular edema is clearly stated

Exclusion Criteria

Do NOT use E10.3399 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination

Clinical Scenario

Used during routine eye exams for diabetic retinopathy screening.

Documentation Requirements

Document findings of the eye exam, including retinopathy severity.

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 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
  • •
    American Academy of Ophthalmology

Coding & Billing References

  • •
    American Diabetes Association
  • •
    American Academy of Ophthalmology

Frequently Asked Questions

What is the significance of moderate nonproliferative diabetic retinopathy?

Moderate NPDR indicates a higher risk of progression to more severe forms of retinopathy, making regular monitoring and management critical.

How often should patients with E10.3399 be monitored?

Patients should have regular eye exams at least annually, or more frequently if retinopathy is present or if diabetes is poorly controlled.