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ICD-10 Guide
ICD-10 CodesE10.3541

E10.3541

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment (right eye)

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

Code Description

ICD-10 E10.3541 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment (right eye).

Key Diagnostic Point:

E10.3541 represents a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) leading to severe vision-threatening conditions, including combined traction and rhegmatogenous retinal detachments in the right eye. PDR occurs when abnormal blood vessels grow on the retina, which can bleed or leak fluid, causing vision impairment. In this case, the traction retinal detachment is caused by the pulling of the retina due to fibrous tissue, while rhegmatogenous retinal detachment occurs due to a tear in the retina itself. Both conditions can lead to significant visual loss if not treated promptly. Management typically involves careful monitoring of blood glucose levels, maintaining HbA1c levels below 7% to prevent further complications, and may require surgical interventions such as vitrectomy or laser therapy. Insulin management is crucial for controlling blood glucose levels, which can help mitigate the progression of diabetic retinopathy and its associated complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple complications involved (PDR, traction, and rhegmatogenous detachments)
  • Specificity required for the right eye
  • Need for detailed documentation of diabetic history and management
  • Potential for overlapping codes in diabetic retinopathy

Audit Risk Factors

  • Inadequate documentation of diabetic history
  • Failure to specify the eye affected
  • Lack of clarity on the type of retinal detachment
  • Inconsistent HbA1c documentation

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, treatment plans, and follow-up care.

Common Clinical Scenarios

Patients presenting with vision changes, diabetic eye exams, and surgical interventions for retinal detachment.

Billing Considerations

Ensure clear documentation of the type of retinal detachment and any surgical procedures performed.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Management of diabetes in patients with complications, adjustments in insulin therapy.

Billing Considerations

Document the impact of diabetes management on ocular health.

Coding Guidelines

Inclusion Criteria

Use E10.3541 When
  • Follow the official ICD
  • CM guidelines for coding diabetes and its complications
  • Ensure accurate documentation of the type of diabetic retinopathy and the specific eye affected
  • Include any relevant treatment details

Exclusion Criteria

Do NOT use E10.3541 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Vitrectomy, mechanical

Clinical Scenario

Used for surgical intervention in cases of retinal detachment.

Documentation Requirements

Document the indication for surgery and findings during the procedure.

Specialty Considerations

Ophthalmology specialists should ensure detailed operative notes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows 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 allows 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 allows 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 specifying the eye affected?

Specifying the eye affected is crucial for treatment planning and understanding the severity of the condition, as management may differ based on the eye involved.

How does HbA1c level impact diabetic retinopathy?

Higher HbA1c levels are associated with an increased risk of developing diabetic retinopathy and its complications, making glycemic control essential in preventing progression.