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ICD-10 Guide
ICD-10 CodesE10.3523

E10.3523

Billable

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

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

Code Description

ICD-10 E10.3523 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 (bilateral).

Key Diagnostic Point:

E10.3523 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has progressed to include traction retinal detachment affecting the macula in both eyes. 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, causing it to detach from the underlying tissue. This condition is particularly concerning as it can lead to significant visual impairment if not treated promptly. Management typically involves close monitoring of blood glucose levels, maintaining HbA1c levels below 7% to prevent further complications, and may require surgical intervention such as vitrectomy to repair the retinal detachment. Insulin management is crucial in controlling blood glucose levels and preventing the progression of diabetic complications.

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.
  • Involvement of multiple specialties (endocrinology and ophthalmology).
  • Potential for additional complications that may need to be coded.

Audit Risk Factors

  • Inadequate documentation of the severity of retinopathy.
  • Failure to document HbA1c levels and diabetes management.
  • Lack of clarity on the bilateral nature of the condition.
  • Insufficient detail on treatment interventions.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Ensure comprehensive documentation of diabetes management and its impact on ocular health.

Ophthalmology

Documentation Requirements

Thorough retinal examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with diabetic retinopathy requiring surgical intervention.

Billing Considerations

Document the specifics of retinal detachment and any surgical procedures performed.

Coding Guidelines

Inclusion Criteria

Use E10.3523 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the patient's condition
  • Include documentation of the type of diabetes, complications, and any relevant treatments

Exclusion Criteria

Do NOT use E10.3523 When
  • Exclude codes that do not specify the type of retinopathy or do not indicate bilateral involvement

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation

Clinical Scenario

Used for treating proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of treatment and patient response.

Specialty Considerations

Ophthalmology should provide detailed notes on the procedure.

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 data collection and reimbursement processes. E10.3523 provides a clear picture of the severity of the patient's condition, which is crucial for treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of data collection and reimbursement processes. E10.3523 provides a clear picture of the severity of the patient's condition, which is crucial for treatment planning and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. E10.3523 provides a clear picture of the severity of the patient's condition, which is crucial for treatment planning and resource allocation.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3523?

Coding E10.3523 accurately reflects the severity of diabetic retinopathy and its complications, which is essential for appropriate treatment and reimbursement.