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ICD-10 Guide
ICD-10 CodesE10.3599

E10.3599

Billable

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

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

Code Description

ICD-10 E10.3599 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema (unspecified eye).

Key Diagnostic Point:

E10.3599 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) without macular edema in an unspecified eye. PDR is a severe form of diabetic retinopathy where new, abnormal 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, leading to ischemia and subsequent neovascularization. The absence of macular edema indicates that there is no swelling in the macula, the central part of the retina responsible for sharp vision. Management of this condition typically involves strict glycemic control, often monitored through HbA1c levels, which should ideally be maintained below 7% to reduce the risk of complications. Insulin therapy is commonly employed to manage blood glucose levels effectively. Regular ophthalmologic examinations are crucial for early detection and management of diabetic retinopathy, as timely intervention can prevent progression to more severe visual impairment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of diabetic retinopathy
  • Understanding the absence of macular edema
  • Managing multiple diabetes-related complications
  • Interpreting HbA1c levels and their implications

Audit Risk Factors

  • Inadequate documentation of eye examination results
  • Failure to specify the eye affected
  • Misclassification of diabetic retinopathy severity
  • Inconsistent HbA1c reporting

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 and complications such as retinopathy.

Billing Considerations

Ensure comprehensive documentation of diabetes management plans and follow-up care.

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 screening.

Billing Considerations

Document the absence of macular edema clearly to support coding.

Coding Guidelines

Inclusion Criteria

Use E10.3599 When
  • According to ICD
  • 10 coding guidelines, E10
  • 3599 should be used when the patient has Type 1 diabetes with proliferative diabetic retinopathy without macular edema
  • It is essential to document the absence of macular edema and specify the eye affected when applicable

Exclusion Criteria

Do NOT use E10.3599 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 screening.

Documentation Requirements

Document findings of the eye exam, including retinopathy status.

Specialty Considerations

Ophthalmologists should ensure detailed notes on retinal findings.

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 diabetes care.

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 diabetes care.

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 diabetes care.

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 absence of macular edema?

Specifying the absence of macular edema is crucial as it differentiates the severity of diabetic retinopathy and impacts treatment decisions and coding accuracy.

How often should patients with E10.3599 be monitored?

Patients should have regular eye examinations, typically annually, or more frequently if retinopathy is present or if there are changes in diabetes management.