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ICD-10 Guide
ICD-10 CodesE09.3539

E09.3539

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (unspecified eye)

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

Code Description

ICD-10 E09.3539 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula (unspecified eye).

Key Diagnostic Point:

E09.3539 refers to diabetes mellitus that is induced by drugs or chemicals, leading to significant complications such as proliferative diabetic retinopathy and traction retinal detachment. Proliferative diabetic retinopathy is characterized by the growth of new blood vessels in the retina, which can lead to severe vision impairment. In this specific case, the traction retinal detachment does not involve the macula, which is crucial for central vision. The condition is often associated with poorly controlled blood glucose levels, indicated by elevated HbA1c levels, and may require insulin management or other pharmacological interventions. The underlying cause of the diabetes must be clearly documented, as it differentiates this condition from other types of diabetes mellitus. Management typically involves a multidisciplinary approach, including endocrinology for diabetes control and ophthalmology for retinal complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise documentation of drug or chemical causation.
  • Involves multiple complications that must be accurately coded.
  • Differentiation from other types of diabetes and retinopathy is necessary.
  • Requires understanding of the relationship between diabetes management and ocular complications.

Audit Risk Factors

  • Inadequate documentation of drug or chemical exposure.
  • Failure to document the specific type of retinopathy.
  • Misalignment between clinical findings and coded conditions.
  • Inconsistent HbA1c levels reported in relation to diabetes management.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed history of diabetes management, including medication history and HbA1c levels.

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes due to medication side effects.

Billing Considerations

Ensure clarity on the causative agent of diabetes and its management.

Ophthalmology

Documentation Requirements

Comprehensive eye examination findings, including details on retinopathy and retinal detachment.

Common Clinical Scenarios

Patients with vision changes due to diabetic retinopathy.

Billing Considerations

Document the extent of retinal detachment and its implications for vision.

Coding Guidelines

Inclusion Criteria

Use E09.3539 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the documentation supports the diagnosis of drug
  • induced diabetes and its complications
  • Include specific details about the drug or chemical involved and the nature of the retinopathy

Exclusion Criteria

Do NOT use E09.3539 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used when a patient with drug-induced diabetes presents for a comprehensive eye exam.

Documentation Requirements

Document the patient's diabetes history, medications, and findings from the eye exam.

Specialty Considerations

Ophthalmologists should be aware of the patient's diabetes management and any related complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of drug-induced diabetes and its complications, improving the accuracy of claims and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of drug-induced diabetes and its complications, improving the accuracy of claims and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 allows for more specific coding of drug-induced diabetes and its complications, improving the accuracy of claims and facilitating better patient management.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of specifying drug-induced diabetes?

Specifying drug-induced diabetes is crucial for accurate treatment planning and management, as it influences the choice of medications and monitoring strategies.