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ICD-10 Guide
ICD-10 CodesE10.3543

E10.3543

Billable

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

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

Code Description

ICD-10 E10.3543 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 (bilateral).

Key Diagnostic Point:

E10.3543 describes a severe complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR), which is the advanced stage of diabetic eye disease. In this condition, abnormal blood vessels grow on the retina, leading to potential vision loss. The presence of both traction retinal detachment and rhegmatogenous retinal detachment indicates that the retina is being pulled away from its normal position due to scar tissue (traction) and also has tears or breaks (rhegmatogenous). This dual pathology can significantly impair vision and requires urgent intervention. Management often involves laser therapy, vitrectomy, or other surgical procedures to address the retinal detachments. The complexity of this condition necessitates careful monitoring of blood glucose levels, as poor glycemic control can exacerbate retinal complications. Regular ophthalmologic evaluations are crucial for early detection and treatment of these complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple complications involved (PDR, traction, and rhegmatogenous detachments)
  • Requires detailed documentation of diabetic history and current management
  • Need for precise coding to reflect bilateral involvement
  • Potential for overlapping codes and conditions

Audit Risk Factors

  • Inadequate documentation of the severity of diabetic retinopathy
  • Failure to specify bilateral involvement
  • Lack of detailed treatment plans or follow-up care
  • Inconsistent HbA1c levels reported

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Management of Type 1 diabetes with complications, adjustments in insulin therapy based on glycemic control.

Billing Considerations

Ensure documentation reflects the impact of diabetes on overall health and any changes in treatment plans.

Ophthalmology

Documentation Requirements

Detailed eye examination reports, imaging studies, and treatment plans for retinal detachment.

Common Clinical Scenarios

Surgical interventions for retinal detachment, monitoring of diabetic retinopathy progression.

Billing Considerations

Document the specific type of retinal detachment and any surgical procedures performed.

Coding Guidelines

Inclusion Criteria

Use E10.3543 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's diabetes type, complications, and any surgical procedures performed
  • Include HbA1c levels to support the severity of diabetes management

Exclusion Criteria

Do NOT use E10.3543 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67208CPT Code

Laser photocoagulation of the retina

Clinical Scenario

Used for treating proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of treatment and follow-up care.

Specialty Considerations

Ophthalmology should provide detailed reports 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 patient records and facilitating better management of complex cases like E10.3543.

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 complex cases like E10.3543.

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 complex cases like E10.3543.

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 coding E10.3543 accurately?

Accurate coding of E10.3543 is crucial for proper reimbursement, tracking of diabetes complications, and ensuring that patients receive appropriate care for their condition.