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ICD-10 Guide
ICD-10 CodesE10.321

E10.321

Billable

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema

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

Code Description

ICD-10 E10.321 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema.

Key Diagnostic Point:

E10.321 refers to a specific complication of Type 1 diabetes mellitus characterized by mild nonproliferative diabetic retinopathy (NPDR) accompanied by macular edema. In Type 1 diabetes, the body does not produce insulin, leading to elevated blood glucose levels. Over time, chronic hyperglycemia can damage blood vessels in the retina, resulting in diabetic retinopathy. Mild NPDR is the earliest stage of diabetic retinopathy, where small retinal blood vessels leak fluid or blood, but there is no significant vision loss. Macular edema occurs when fluid accumulates in the macula, the central part of the retina responsible for sharp vision, potentially leading to vision impairment. Management of this condition typically involves controlling blood glucose levels, monitoring HbA1c levels (ideally below 7% for most adults), and may include insulin therapy. Regular eye examinations are crucial for early detection and management of diabetic retinopathy and its complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Need for accurate documentation of retinopathy severity
  • Differentiation between NPDR and proliferative diabetic retinopathy
  • Management of associated conditions like macular edema

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Incorrect coding of associated conditions
  • Lack of follow-up documentation for diabetic eye exams

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, requiring insulin adjustments.

Billing Considerations

Ensure documentation reflects the type of diabetes and any complications.

Ophthalmology

Documentation Requirements

Comprehensive eye exam reports detailing findings of diabetic retinopathy.

Common Clinical Scenarios

Patients with diabetes undergoing routine eye exams or treatment for retinopathy.

Billing Considerations

Document the severity of retinopathy and any treatments administered.

Coding Guidelines

Inclusion Criteria

Use E10.321 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the type of diabetes and associated complications
  • Include specific details about the severity of retinopathy and any treatments provided

Exclusion Criteria

Do NOT use E10.321 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 retinopathy and any treatments recommended.

Specialty Considerations

Ophthalmologists should ensure detailed notes on retinopathy severity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, enhancing the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, enhancing the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, enhancing the ability to track and manage these conditions effectively.

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 E10.321?

Coding E10.321 accurately reflects the presence of mild nonproliferative diabetic retinopathy with macular edema in patients with Type 1 diabetes, which is crucial for appropriate management and treatment planning.