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ICD-10 Guide
ICD-10 CodesE10.3542

E10.3542

Billable

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

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

Code Description

ICD-10 E10.3542 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 (left eye).

Key Diagnostic Point:

E10.3542 represents a complex condition where a patient with Type 1 diabetes mellitus experiences severe ocular complications, specifically proliferative diabetic retinopathy (PDR) leading to both traction and rhegmatogenous retinal detachments in the left eye. PDR is characterized by the growth of new blood vessels on the retina, which can lead to bleeding and scarring. The combined retinal detachments indicate that the retina has been pulled away from its normal position due to both the traction from the abnormal blood vessels and the presence of tears or holes in the retina. This condition requires urgent medical intervention, often involving surgical procedures such as vitrectomy or laser therapy to prevent permanent vision loss. Management of the underlying diabetes is crucial, as maintaining optimal blood glucose levels can help mitigate further complications. Regular monitoring of HbA1c levels is essential, with targets typically set below 7% to reduce the risk of diabetic complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple ocular complications requiring precise documentation.
  • Differentiation between traction and rhegmatogenous detachments.
  • Specificity of the eye involved (left eye).
  • Need for detailed clinical history and management plans.

Audit Risk Factors

  • Inadequate documentation of the type of retinal detachment.
  • Failure to document the severity of diabetic retinopathy.
  • Lack of clear linkage between diabetes management and ocular complications.
  • Insufficient detail on treatment interventions performed.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed ocular examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with vision changes, floaters, or sudden vision loss due to retinal detachment.

Billing Considerations

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

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including HbA1c levels and treatment regimens.

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the relationship between diabetes control and ocular health.

Coding Guidelines

Inclusion Criteria

Use E10.3542 When
  • Follow ICD
  • CM guidelines for coding diabetes and its complications
  • Ensure that the documentation supports the diagnosis of both the diabetes type and the specific ocular complications
  • Include any relevant co
  • morbidities

Exclusion Criteria

Do NOT use E10.3542 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

Ophthalmologists should ensure clear documentation of the procedure and its necessity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding diabetes and its complications, enabling better tracking of patient outcomes and resource allocation. E10.3542 reflects the complexity of managing diabetes-related ocular conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding diabetes and its complications, enabling better tracking of patient outcomes and resource allocation. E10.3542 reflects the complexity of managing diabetes-related ocular conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding diabetes and its complications, enabling better tracking of patient outcomes and resource allocation. E10.3542 reflects the complexity of managing diabetes-related ocular 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 type of retinal detachment?

Specifying the type of retinal detachment is crucial for accurate coding and treatment planning, as it influences the management approach and potential outcomes.

How often should HbA1c levels be monitored in patients with diabetic retinopathy?

Patients with diabetic retinopathy should have their HbA1c levels monitored at least every 3 to 6 months, depending on their treatment plan and stability of their diabetes.