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ICD-10 Guide
ICD-10 CodesE10.3313

E10.3313

Billable

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

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

Code Description

ICD-10 E10.3313 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (bilateral).

Key Diagnostic Point:

E10.3313 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by moderate nonproliferative diabetic retinopathy (NPDR) 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 due to prolonged hyperglycemia. Moderate NPDR is identified by the presence of microaneurysms, retinal hemorrhages, and exudates, while macular edema indicates fluid accumulation in the macula, leading to vision impairment. This condition requires careful monitoring and management, including regular eye examinations and potential interventions such as laser therapy or intravitreal injections to prevent progression to more severe forms of retinopathy. The management of Type 1 diabetes involves insulin therapy, with the goal of maintaining HbA1c levels below 7% to minimize complications. Regular monitoring of blood glucose levels is essential to prevent acute complications such as diabetic ketoacidosis and chronic complications affecting the eyes, kidneys, and nerves.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes classifications and complications.
  • Involves knowledge of specific retinopathy stages and their implications.
  • Documentation must clearly indicate the presence of both diabetes and retinopathy.
  • Need for accurate coding of bilateral conditions.

Audit Risk Factors

  • Inadequate documentation of retinopathy severity.
  • Failure to specify bilateral involvement.
  • Inconsistent HbA1c levels reported.
  • Lack of follow-up documentation for diabetic management.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes or complications requiring insulin adjustments.

Billing Considerations

Ensure clear documentation of diabetes type and associated complications.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports detailing the findings of diabetic retinopathy.

Common Clinical Scenarios

Patients undergoing routine diabetic eye exams or treatment for retinopathy.

Billing Considerations

Document the severity of retinopathy and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.3313 When
  • According to ICD
  • 10 guidelines, E10
  • 3313 should be used when the documentation specifies Type 1 diabetes with moderate NPDR and bilateral macular edema
  • Ensure that the documentation supports the diagnosis and includes details about the severity of retinopathy

Exclusion Criteria

Do NOT use E10.3313 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 and any interventions.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of 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 coding E10.3313?

Coding E10.3313 accurately reflects the patient's condition, ensuring appropriate management and reimbursement for the complexities associated with Type 1 diabetes and its complications.