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ICD-10 Guide
ICD-10 CodesE10.31

E10.31

Billable

Type 1 diabetes mellitus with unspecified diabetic retinopathy

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

Code Description

ICD-10 E10.31 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with unspecified diabetic retinopathy.

Key Diagnostic Point:

E10.31 refers to Type 1 diabetes mellitus, a chronic condition characterized by the body's inability to produce insulin due to autoimmune destruction of pancreatic beta cells. This specific code indicates the presence of diabetic retinopathy, a common complication of diabetes that affects the eyes, leading to potential vision loss. Diabetic retinopathy can manifest in various forms, including non-proliferative and proliferative stages, but in this case, it is unspecified, meaning the exact type or severity is not documented. Patients with Type 1 diabetes often have fluctuating blood glucose levels, which can lead to complications such as retinopathy. Regular monitoring of HbA1c levels is crucial, as maintaining these levels below 7% can significantly reduce the risk of developing retinopathy. Insulin management is essential for controlling blood glucose levels, and patients may require multiple daily injections or an insulin pump. The management of diabetic retinopathy may involve regular eye examinations, laser therapy, or intravitreal injections, depending on the severity of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of retinopathy stages
  • Need for precise HbA1c level documentation
  • Differentiation between Type 1 and Type 2 diabetes
  • Potential for multiple complications requiring additional codes

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of clear insulin management records
  • Inconsistent coding of diabetes types

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of insulin therapy, HbA1c levels, and diabetes management plans.

Common Clinical Scenarios

Patients presenting with uncontrolled blood glucose levels or complications related to diabetes.

Billing Considerations

Ensure comprehensive documentation of all diabetes-related complications and treatments.

Ophthalmology

Documentation Requirements

Thorough eye examination reports, including findings related to diabetic retinopathy.

Common Clinical Scenarios

Patients with visual disturbances or routine diabetic eye exams.

Billing Considerations

Document the specific type of retinopathy when possible to avoid unspecified coding.

Coding Guidelines

Inclusion Criteria

Use E10.31 When
  • According to ICD
  • 10 guidelines, E10
  • 31 should be used when a patient with Type 1 diabetes has diabetic retinopathy that is not specified
  • Coders must ensure that the documentation supports the diagnosis and that other potential complications are coded appropriately

Exclusion Criteria

Do NOT use E10.31 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 patients.

Documentation Requirements

Document findings of the eye exam, including any signs of retinopathy.

Specialty Considerations

Ophthalmologists should ensure that the examination includes a thorough assessment of diabetic complications.

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 reimbursement processes. E10.31 provides a clear indication of Type 1 diabetes with retinopathy, which was less specific in ICD-9.

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 reimbursement processes. E10.31 provides a clear indication of Type 1 diabetes with retinopathy, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. E10.31 provides a clear indication of Type 1 diabetes with retinopathy, which was less specific in ICD-9.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of specifying diabetic retinopathy?

Specifying the type of diabetic retinopathy is crucial for treatment planning and understanding the severity of the patient's condition. It also impacts coding accuracy and reimbursement.