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ICD-10 Guide
ICD-10 CodesE10.3551

E10.3551

Billable

Type 1 diabetes mellitus with stable proliferative diabetic retinopathy (right eye)

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

Code Description

ICD-10 E10.3551 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with stable proliferative diabetic retinopathy (right eye).

Key Diagnostic Point:

E10.3551 refers to Type 1 diabetes mellitus characterized by the presence of stable proliferative diabetic retinopathy in the right eye. Type 1 diabetes is an autoimmune condition where the pancreas produces little to no insulin, leading to elevated blood glucose levels. Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes, marked by the growth of new blood vessels in the retina, which can lead to vision loss. The term 'stable' indicates that the condition has not worsened, and the patient is under appropriate management. Regular monitoring of HbA1c levels is crucial, as it reflects long-term glucose control. Insulin management is essential for Type 1 diabetes, often requiring multiple daily injections or an insulin pump. Patients with PDR may also require additional interventions, such as laser therapy or anti-VEGF injections, to prevent further retinal damage. Comprehensive management includes regular eye examinations, glycemic control, and education on diabetes self-management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and complications
  • Knowledge of specific eye conditions related to diabetes
  • Need for accurate documentation of stable vs. unstable conditions
  • Differentiation between right and left eye involvement

Audit Risk Factors

  • Inadequate documentation of eye examinations
  • Failure to document HbA1c levels
  • Misclassification of the eye affected
  • Lack of evidence for stable condition

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of diabetes management, including insulin regimens and HbA1c levels.

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes or complications requiring insulin adjustments.

Billing Considerations

Ensure documentation reflects the patient's diabetes type and any complications.

Ophthalmology

Documentation Requirements

Comprehensive eye exam reports, including findings related to diabetic retinopathy.

Common Clinical Scenarios

Patients undergoing routine eye exams for diabetic retinopathy.

Billing Considerations

Document the stability of the retinopathy and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use E10.3551 When
  • Follow the official ICD
  • CM guidelines for coding diabetes and its complications
  • Ensure that the documentation supports the diagnosis, including the type of diabetes, presence of complications, and any treatments administered

Exclusion Criteria

Do NOT use E10.3551 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 diabetic retinopathy.

Documentation Requirements

Document findings of the eye exam, including any changes in retinopathy.

Specialty Considerations

Ophthalmologists should ensure thorough documentation of diabetic complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes and its complications, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes and its complications, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What does 'stable' mean in the context of diabetic retinopathy?

'Stable' indicates that the condition has not worsened over time and that the patient is under effective management, with no new complications arising.