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ICD-10 Guide
ICD-10 CodesE10.3319

E10.3319

Billable

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

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

Code Description

ICD-10 E10.3319 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (unspecified eye).

Key Diagnostic Point:

E10.3319 refers to a specific condition in patients with Type 1 diabetes mellitus characterized by moderate nonproliferative diabetic retinopathy (NPDR) accompanied by macular edema in an unspecified eye. Type 1 diabetes is an autoimmune condition leading to the destruction of insulin-producing beta cells in the pancreas, resulting in absolute insulin deficiency. Diabetic retinopathy is a common complication of diabetes, where high blood sugar levels damage the blood vessels in the retina. Moderate NPDR indicates the presence of microaneurysms, retinal hemorrhages, and exudates, but without the severe complications seen in proliferative diabetic retinopathy. Macular edema, a result of fluid accumulation in the macula, can lead to vision impairment. Management of this condition often involves strict glycemic control, with HbA1c levels ideally maintained below 7% to prevent further retinal damage. Insulin therapy is crucial for Type 1 diabetes management, and regular ophthalmologic evaluations are essential for early detection and treatment of retinopathy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the eye affected is unspecified.
  • Requires understanding of diabetic retinopathy stages.
  • Involves knowledge of diabetes management and complications.
  • Documentation must reflect both diabetes and retinopathy status.

Audit Risk Factors

  • Inadequate documentation of retinopathy severity.
  • Failure to document HbA1c levels.
  • Lack of clear linkage between diabetes management and retinopathy.
  • Inconsistent coding of eye conditions.

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 and complications.

Billing Considerations

Ensure documentation reflects the relationship between diabetes control and retinopathy.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Routine diabetic eye exams showing progression of retinopathy.

Billing Considerations

Document the specific eye affected and the severity of findings.

Coding Guidelines

Inclusion Criteria

Use E10.3319 When
  • According to ICD
  • 10 guidelines, E10
  • 3319 should be used when there is a confirmed diagnosis of Type 1 diabetes with moderate NPDR and macular edema
  • Documentation must support the diagnosis, including clinical findings and treatment plans

Exclusion Criteria

Do NOT use E10.3319 When
  • Exclusion criteria include other types of diabetes or retinopathy not meeting the specified criteria

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 treatment plans.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinal 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 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 specifying the eye affected in E10.3319?

Specifying the eye affected is crucial for accurate diagnosis and treatment planning, as it impacts management strategies and potential interventions.