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ICD-10 Guide
ICD-10 CodesE10.3521

E10.3521

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula (right eye)

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

Code Description

ICD-10 E10.3521 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula (right eye).

Key Diagnostic Point:

E10.3521 refers to a specific condition in patients with Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has progressed to include traction retinal detachment affecting the macula of the right eye. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, which can lead to vision loss. The presence of traction retinal detachment indicates that these abnormal vessels are pulling on the retina, potentially causing it to detach from the underlying tissue. This condition is often associated with poor glycemic control, indicated by elevated HbA1c levels, which reflect chronic hyperglycemia. Management typically involves insulin therapy to maintain blood glucose levels within target ranges, alongside regular ophthalmologic evaluations to monitor retinal health. Early intervention is crucial to prevent irreversible vision loss, and treatment options may include laser photocoagulation or vitrectomy, depending on the severity of the detachment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition (Type 1 diabetes with PDR and traction retinal detachment)
  • Need for precise documentation of eye involvement (right eye, macula)
  • Differentiation from other types of diabetic retinopathy
  • Potential for multiple complications requiring detailed coding

Audit Risk Factors

  • Inadequate documentation of eye examination findings
  • Failure to document HbA1c levels and diabetes management
  • Misclassification of the type of diabetic retinopathy
  • Lack of clarity on the extent of retinal detachment

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled Type 1 diabetes presenting with complications.

Billing Considerations

Ensure comprehensive documentation of diabetes management and any referrals to ophthalmology.

Ophthalmology

Documentation Requirements

Thorough documentation of retinal examinations, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with diabetic retinopathy requiring laser treatment or surgical intervention.

Billing Considerations

Document the specific eye affected and the nature of the retinal detachment.

Coding Guidelines

Inclusion Criteria

Use E10.3521 When
  • According to ICD
  • 10 coding guidelines, E10
  • 3521 should be used when there is a confirmed diagnosis of Type 1 diabetes with proliferative diabetic retinopathy and traction retinal detachment involving the macula of the right eye
  • Documentation must clearly indicate the type of diabetes, the presence of retinopathy, and the specific eye affected

Exclusion Criteria

Do NOT use E10.3521 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the indication for laser treatment and the extent of the procedure.

Specialty Considerations

Ophthalmologists should ensure that the diagnosis aligns with the procedure performed.

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 diabetic conditions.

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 diabetic conditions.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of specifying the eye affected in E10.3521?

Specifying the eye affected is crucial for treatment planning and monitoring, as it directly impacts the management of the patient's vision and the type of interventions required.