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ICD-10 Guide
ICD-10 CodesE10.3412

E10.3412

Billable

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

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

Code Description

ICD-10 E10.3412 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema (left eye).

Key Diagnostic Point:

E10.3412 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by severe nonproliferative diabetic retinopathy (NPDR) 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. Severe NPDR is indicated by the presence of extensive retinal hemorrhages, cotton wool spots, and venous beading, which can lead to vision impairment. Macular edema, a condition where fluid accumulates in the macula, can further exacerbate vision loss. Management of this condition typically involves strict glycemic control, often monitored through HbA1c levels, which should ideally be maintained below 7% to prevent complications. Insulin therapy is essential for Type 1 diabetes management, and patients may require adjustments based on their blood glucose levels and dietary intake. Regular ophthalmologic examinations are crucial for early detection and management of diabetic retinopathy.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition requiring detailed documentation.
  • Need for accurate differentiation between types of diabetic retinopathy.
  • Management of multiple complications associated with diabetes.
  • Potential for overlapping codes related to diabetes and its complications.

Audit Risk Factors

  • Inadequate documentation of the severity of retinopathy.
  • Failure to document HbA1c levels and their management.
  • Lack of clear differentiation between eye conditions.
  • Inconsistent coding of diabetes-related complications.

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.

Billing Considerations

Ensure comprehensive documentation of diabetes management plans and patient education.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Patients with visual disturbances due to diabetic retinopathy.

Billing Considerations

Document the severity of retinopathy and any treatments administered.

Coding Guidelines

Inclusion Criteria

Use E10.3412 When
  • According to ICD
  • 10 guidelines, E10
  • 3412 should be used when the documentation specifies Type 1 diabetes with severe NPDR and macular edema in the left eye
  • Coders must ensure that the documentation supports the severity of the retinopathy and the presence of macular edema

Exclusion Criteria

Do NOT use E10.3412 When
  • Exclusion criteria include other types of diabetes or retinopathy not specified in the code

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used during routine eye exams for diabetic retinopathy.

Documentation Requirements

Document findings of the eye examination and any treatments recommended.

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 more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

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 facilitating better management of diabetes and its complications.

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3412?

Coding E10.3412 accurately reflects the severity of diabetic retinopathy and the specific eye affected, which is crucial for appropriate management and treatment planning.