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ICD-10 Guide
ICD-10 CodesE10.3213

E10.3213

Billable

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (bilateral)

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

Code Description

ICD-10 E10.3213 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (bilateral).

Key Diagnostic Point:

E10.3213 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by mild nonproliferative diabetic retinopathy and bilateral macular edema. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. Diabetic retinopathy is a common complication of diabetes, resulting from damage to the retinal blood vessels. In the case of mild nonproliferative diabetic retinopathy, there are early signs of retinal damage, such as microaneurysms and retinal hemorrhages, but no new blood vessel growth (neovascularization) is present. Macular edema, a condition where fluid accumulates in the macula, can lead to vision impairment. The presence of bilateral macular edema indicates that both eyes are affected, which can significantly impact the patient's quality of life. Management of this condition typically involves tight glycemic control, regular ophthalmologic evaluations, and possibly the use of anti-VEGF injections or laser therapy to address the macular edema.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Involves knowledge of specific eye conditions related to diabetes
  • Need for precise documentation of retinopathy severity
  • Bilateral nature of the condition must be clearly indicated

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to specify bilateral involvement
  • Lack of clear linkage between diabetes management and retinopathy treatment
  • Misclassification of retinopathy type

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of diabetes management, including HbA1c levels and insulin regimen.

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes, requiring insulin adjustments.

Billing Considerations

Ensure documentation reflects the patient's diabetes type and any complications.

Ophthalmology

Documentation Requirements

Comprehensive eye exam reports detailing findings of retinopathy and macular edema.

Common Clinical Scenarios

Routine diabetic eye exams and treatment for diabetic retinopathy.

Billing Considerations

Document the severity of retinopathy and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.3213 When
  • According to ICD
  • 10 coding guidelines, E10
  • 3213 should be used when a patient with Type 1 diabetes has documented mild nonproliferative diabetic retinopathy and bilateral macular edema
  • Coders must ensure that the documentation supports the diagnosis and that the bilateral nature of the condition is clearly indicated

Exclusion Criteria

Do NOT use E10.3213 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

Complete eye exam documentation including findings.

Specialty Considerations

Ophthalmologists must document the severity of 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-related complications, improving the accuracy of patient records and facilitating better management of diabetic conditions.

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 facilitating better management of diabetic conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetic conditions.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3213 accurately?

Accurate coding of E10.3213 is crucial for proper reimbursement, ensuring that patients receive appropriate care for their diabetes and its complications. It also aids in tracking the prevalence of diabetic retinopathy and informs treatment protocols.