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ICD-10 Guide
ICD-10 CodesE09.3541

E09.3541

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment (right eye)

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

Code Description

ICD-10 E09.3541 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment (right eye).

Key Diagnostic Point:

E09.3541 refers to diabetes mellitus that has been induced by drugs or chemicals, leading to significant complications such as proliferative diabetic retinopathy. This condition is characterized by the growth of abnormal blood vessels in the retina, which can lead to vision loss. In this specific case, the patient presents with both traction retinal detachment and rhegmatogenous retinal detachment in the right eye. Traction retinal detachment occurs when scar tissue pulls the retina away from the underlying tissue, while rhegmatogenous retinal detachment is caused by a tear or break in the retina. The management of this condition requires careful monitoring of blood glucose levels, typically assessed through HbA1c levels, and may involve insulin therapy to control diabetes. The presence of proliferative diabetic retinopathy indicates a severe form of the disease, necessitating potential surgical interventions to address the retinal detachments and prevent further vision loss.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple complications involved (retinal detachment types)
  • Specificity of drug or chemical-induced diabetes
  • Need for precise documentation of eye conditions
  • Potential for overlapping diagnoses

Audit Risk Factors

  • Inadequate documentation of drug or chemical exposure
  • Failure to specify the type of retinal detachment
  • Lack of clear linkage between diabetes management and eye complications
  • Inconsistent HbA1c reporting

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with drug-induced diabetes requiring insulin therapy and monitoring.

Billing Considerations

Ensure documentation reflects the cause of diabetes and its management.

Ophthalmology

Documentation Requirements

Comprehensive eye examination findings, including details of retinal detachment.

Common Clinical Scenarios

Patients presenting with vision changes due to diabetic retinopathy.

Billing Considerations

Document the type of retinal detachment and any surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use E09.3541 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the primary diagnosis reflects the cause of diabetes
  • Include additional codes for complications such as retinal detachment
  • Ensure that documentation supports the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use E09.3541 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Vitrectomy, mechanical

Clinical Scenario

Used for surgical repair of retinal detachment in patients with diabetic retinopathy.

Documentation Requirements

Document the indication for surgery and the patient's diabetic status.

Specialty Considerations

Ophthalmologists should ensure that the surgical necessity is clearly linked to the diabetic condition.

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 claims and facilitating better patient management. E09.3541 provides a detailed description of the patient's condition, which can enhance care coordination and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management. E09.3541 provides a detailed description of the patient's condition, which can enhance care coordination and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management. E09.3541 provides a detailed description of the patient's condition, which can enhance care coordination and outcomes.

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 coding E09.3541?

Coding E09.3541 accurately reflects the complexity of a patient's condition, including the specific cause of diabetes and its severe complications, which is crucial for appropriate management and reimbursement.