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ICD-10 Guide
ICD-10 CodesE10.3311

E10.3311

Billable

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (right eye)

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

Code Description

ICD-10 E10.3311 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (right eye).

Key Diagnostic Point:

E10.3311 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by moderate nonproliferative diabetic retinopathy (NPDR) and macular edema in the right eye. 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 due to prolonged hyperglycemia. Moderate NPDR indicates that there are noticeable changes in the retina, such as microaneurysms and retinal hemorrhages, but without the severe complications seen in proliferative diabetic retinopathy. Macular edema, a condition where fluid accumulates in the macula, can lead to vision impairment. Management of this condition often involves strict glycemic control, regular eye examinations, and potentially treatments such as laser therapy or intravitreal injections to reduce edema and prevent further vision loss.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the eye affected (right eye)
  • Differentiation between types of diabetic retinopathy
  • Need for detailed documentation of diabetes management
  • Understanding of associated complications and their management

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of clarity on the specific eye affected
  • Inconsistent coding of diabetes management interventions

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including the presence and extent of edema and retinopathy.

Common Clinical Scenarios

Patients presenting with vision changes, routine diabetic eye exams, and follow-up for diabetic retinopathy.

Billing Considerations

Ensure documentation includes specific findings related to the right eye and any treatments administered.

Endocrinology

Documentation Requirements

Comprehensive diabetes management plan, including insulin regimen and HbA1c levels.

Common Clinical Scenarios

Management of Type 1 diabetes, monitoring for complications, and adjustments in insulin therapy.

Billing Considerations

Document the patient's glycemic control and any referrals to ophthalmology for retinopathy management.

Coding Guidelines

Inclusion Criteria

Use E10.3311 When
  • According to ICD
  • 10 guidelines, E10
  • 3311 should be used when documenting Type 1 diabetes with specific complications
  • Coders must ensure that the documentation supports the diagnosis of moderate NPDR with macular edema and specify the affected eye

Exclusion Criteria

Do NOT use E10.3311 When
  • Exclusion criteria include cases where the retinopathy is not specified or if the diabetes type is incorrectly documented

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 retinopathy assessment.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of diabetic retinopathy findings.

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 diabetes and its complications.

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 diabetes and its complications.

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 diabetes and its complications.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of specifying the eye affected?

Specifying the eye affected is crucial for treatment planning and monitoring progression, as diabetic retinopathy can affect each eye differently.