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ICD-10 Guide
ICD-10 CodesE10.3591

E10.3591

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema (right eye)

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

Code Description

ICD-10 E10.3591 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema (right eye).

Key Diagnostic Point:

E10.3591 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) affecting the right eye, without the presence of macular edema. PDR is a severe form of diabetic retinopathy where new blood vessels grow on the retina, which can lead to vision loss. This condition arises due to chronic hyperglycemia, which damages the retinal blood vessels. The absence of macular edema indicates that while there is significant retinal damage, the central vision area (macula) is not yet affected by swelling. Management of this condition often involves regular ophthalmologic examinations, strict glycemic control, and may include laser therapy or anti-VEGF injections to prevent further complications. The patient's HbA1c levels are crucial in monitoring diabetes control, with levels above 7% indicating poor control and increased risk of complications like PDR.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the eye affected (right eye)
  • Differentiation between proliferative and non-proliferative retinopathy
  • Exclusion of macular edema
  • Need for detailed documentation of diabetes management

Audit Risk Factors

  • Inadequate documentation of eye examinations
  • Failure to specify the eye affected
  • Lack of clarity on the presence or absence of macular edema
  • Inconsistent HbA1c documentation

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including presence of neovascularization and macular status.

Common Clinical Scenarios

Patients presenting with blurred vision or floaters due to PDR.

Billing Considerations

Ensure clear documentation of the eye affected and any treatments administered.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the patient's overall diabetes management plan and any referrals to ophthalmology.

Coding Guidelines

Inclusion Criteria

Use E10.3591 When
  • According to ICD
  • 10 guidelines, this code should be used when the patient has Type 1 diabetes with documented proliferative diabetic retinopathy affecting the right eye, without macular edema
  • Documentation must clearly indicate the absence of macular edema and specify the eye involved

Exclusion Criteria

Do NOT use E10.3591 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the indication for laser treatment and the specific findings of PDR.

Specialty Considerations

Ophthalmologists should ensure that the procedure is linked to the correct diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed 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 has allowed 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 has allowed 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 in E10.3591?

Specifying the eye affected is crucial for treatment planning and monitoring, as it impacts the management of diabetic retinopathy and potential vision outcomes.