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ICD-10 Guide
ICD-10 CodesE10.355

E10.355

Billable

Type 1 diabetes mellitus with stable proliferative diabetic retinopathy

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

Code Description

ICD-10 E10.355 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with stable proliferative diabetic retinopathy.

Key Diagnostic Point:

E10.355 refers to Type 1 diabetes mellitus characterized by the presence of stable proliferative diabetic retinopathy (PDR). PDR is a serious complication of diabetes where abnormal blood vessels grow in the retina, potentially leading to vision loss. In patients with Type 1 diabetes, which is typically diagnosed in childhood or adolescence, the risk of developing diabetic retinopathy increases with the duration of the disease. Stable PDR indicates that while the condition is present, it has not progressed or worsened, suggesting effective management of blood glucose levels and regular ophthalmologic monitoring. Management of Type 1 diabetes often involves insulin therapy, with the goal of maintaining HbA1c levels below 7% to minimize complications. Regular eye examinations are crucial for early detection and management of retinopathy. This code is essential for capturing the complexity of diabetes management and the associated ocular complications, which require a multidisciplinary approach for optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Involves knowledge of stable versus unstable diabetic retinopathy
  • Need for accurate documentation of HbA1c levels
  • Insulin management protocols must be considered

Audit Risk Factors

  • Inadequate documentation of retinopathy status
  • Failure to document HbA1c levels
  • Lack of evidence for insulin management plans
  • Inconsistent coding of diabetes complications

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of insulin therapy, HbA1c levels, and diabetes management plans.

Common Clinical Scenarios

Patients presenting with fluctuating blood glucose levels, requiring adjustments in insulin therapy.

Billing Considerations

Endocrinologists must ensure comprehensive documentation of diabetes management to support coding.

Ophthalmology

Documentation Requirements

Thorough documentation of retinal examinations, including findings related to proliferative diabetic retinopathy.

Common Clinical Scenarios

Patients undergoing routine eye exams for diabetic retinopathy monitoring.

Billing Considerations

Ophthalmologists should clearly document the stability of retinopathy to support the use of E10.355.

Coding Guidelines

Inclusion Criteria

Use E10.355 When
  • According to ICD
  • 10 guidelines, E10
  • 355 should be used when a patient with Type 1 diabetes has stable proliferative diabetic retinopathy
  • It is important to document the stability of the condition and any relevant management strategies

Exclusion Criteria

Do NOT use E10.355 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used during routine eye exams for patients with diabetes.

Documentation Requirements

Document findings of retinal examination and any changes in management.

Specialty Considerations

Ophthalmologists should ensure that the examination details support the diagnosis of stable PDR.

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 chronic conditions like diabetes.

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 chronic conditions like diabetes.

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 chronic conditions like diabetes.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What does stable proliferative diabetic retinopathy mean?

Stable proliferative diabetic retinopathy indicates that while abnormal blood vessel growth is present in the retina, it has not progressed or worsened, suggesting effective management of diabetes.