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ICD-10 Guide
ICD-10 CodesE10.3531

E10.3531

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (right eye)

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

Code Description

ICD-10 E10.3531 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (right eye).

Key Diagnostic Point:

E10.3531 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has led to traction retinal detachment in the right eye, without involvement of the macula. Proliferative diabetic retinopathy is a severe form of diabetic eye disease where new, abnormal blood vessels grow on the retina, which can lead to vision loss. The traction retinal detachment occurs when these new vessels pull 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 monitoring blood glucose levels, maintaining HbA1c levels below 7% to prevent further complications, and may require surgical intervention to repair the detachment. Insulin management is crucial for patients with Type 1 diabetes, as it directly influences blood glucose control and, consequently, the risk of developing diabetic complications such as retinopathy.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the eye condition (right eye traction retinal detachment)
  • Differentiation between types of diabetic retinopathy
  • Need for precise documentation of diabetes management and HbA1c levels
  • Potential for multiple complications requiring careful coding

Audit Risk Factors

  • Inadequate documentation of HbA1c levels
  • Failure to specify the eye affected
  • Lack of clarity on the severity of retinopathy
  • Inconsistent coding of diabetes management

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed examination findings, imaging results, and treatment plans for retinal detachment.

Common Clinical Scenarios

Patients presenting with vision changes, floaters, or flashes of light due to retinal detachment.

Billing Considerations

Ensure clear documentation of the type of retinal detachment and its relation to diabetic retinopathy.

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including insulin regimen and HbA1c levels.

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the impact of diabetes management on ocular health.

Coding Guidelines

Inclusion Criteria

Use E10.3531 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the type of diabetes, the presence of complications, and the specific eye affected
  • Include any relevant clinical findings and treatment plans

Exclusion Criteria

Do NOT use E10.3531 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of treatment and follow-up care.

Specialty Considerations

Ophthalmology should ensure clear documentation of the procedure and its indications.

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

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.

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 the eye affected?

Specifying the eye affected is crucial for treatment planning and for understanding the extent of the disease, as management may differ based on whether one or both eyes are involved.