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ICD-10 Guide
ICD-10 CodesE09.359

E09.359

Billable

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema

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

Code Description

ICD-10 E09.359 is a billable code used to indicate a diagnosis of drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema.

Key Diagnostic Point:

E09.359 refers to diabetes mellitus that is induced by drugs or chemicals, characterized by the presence of proliferative diabetic retinopathy without macular edema. This condition arises when certain medications or toxic substances lead to insulin resistance or impaired insulin secretion, resulting in hyperglycemia. Proliferative diabetic retinopathy is a severe complication of diabetes, marked by the growth of new blood vessels in the retina, which can lead to vision loss. 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 often involves controlling blood glucose levels through insulin therapy or oral hypoglycemic agents, monitoring HbA1c levels to assess long-term glucose control, and regular eye examinations to monitor retinal changes. The interplay between drug-induced diabetes and its complications necessitates a comprehensive approach to treatment and coding.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between drug-induced and other types of diabetes mellitus.
  • Understanding the specific medications or chemicals that can induce diabetes.
  • Recognizing the nuances of diabetic retinopathy stages and their coding implications.
  • Documenting the absence of macular edema accurately.

Audit Risk Factors

  • Inadequate documentation of the drug or chemical responsible for diabetes.
  • Failure to document the presence or absence of macular edema.
  • Misclassification of the type of diabetic retinopathy.
  • Inconsistent HbA1c levels not correlating with the documented diabetes management.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed medication history, HbA1c levels, and management plans.

Common Clinical Scenarios

Patients presenting with new-onset diabetes after starting a specific medication.

Billing Considerations

Ensure clear documentation of the timeline between medication initiation and diabetes onset.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports, including retinal imaging.

Common Clinical Scenarios

Patients with diabetes presenting for routine eye exams showing signs of retinopathy.

Billing Considerations

Document the specific findings of proliferative diabetic retinopathy and the absence of macular edema.

Coding Guidelines

Inclusion Criteria

Use E09.359 When
  • According to ICD
  • 10 guidelines, E09
  • 359 should be used when diabetes is specifically induced by drugs or chemicals, and it is crucial to document the specific agent responsible
  • The absence of macular edema must be clearly stated in the medical record
  • Regular updates to coding guidelines should be reviewed to ensure compliance

Exclusion Criteria

Do NOT use E09.359 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used for routine eye exams in diabetic patients.

Documentation Requirements

Complete eye exam findings, including retinal assessment.

Specialty Considerations

Ophthalmologists should document the specific findings related to diabetic retinopathy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes types and complications, improving the accuracy of claims and facilitating better patient management. E09.359 reflects the need for detailed documentation of drug-induced conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes types and complications, improving the accuracy of claims and facilitating better patient management. E09.359 reflects the need for detailed documentation of drug-induced conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes types and complications, improving the accuracy of claims and facilitating better patient management. E09.359 reflects the need for detailed documentation of drug-induced conditions.

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 medications can induce diabetes mellitus?

Several classes of medications can induce diabetes, including corticosteroids, certain antipsychotics, and some antihypertensives. It is essential to document the specific medication and its duration of use.